MO918: The Time to Negative Conversion Among Adult COVID-19 Patients on Chronic Hemodialysis Admitted at the Philippine General Hospital
Authors: May Valmoria Kristine , Nikolai So Paolo , Montemayor Elizabeth 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In the Philippines, the shortage of dialysis centers that cater to ESKD individuals who tested positive for COVID-19 uniquely presents a logistic challenge, as these patients remain admitted in COVID-19 hospitals with hemodialysis units despite the clinical resolution of their disease. The majority of free-standing hemodialysis units require proof of negative conversion despite recommendations from local guidelines.
As proof of negative conversion remains important in many practical settings, the negative conversion rate of SARS-CoV-2 infection has been the subject of several investigations. However, negative conversion rates particularly for ESKD patients with COVID-19 infection are lacking.
Hence, this study aims to determine the time to negative conversion of COVID-19 RT-PCR testing among adult COVID-19 patients on chronic hemodialysis admitted at the Philippine General Hospital (PGH), a tertiary government hospital assigned as one of the COVID-19 referral centers in the country. This knowledge will allow for a more systematic and evidence-based implementation of the test-based approach, ultimately determining whether such an approach can be shifted to a symptom or time-based procedure in order to shorten the isolation period and conserve resources, especially in resource-limited settings.

METHOD
This is a retrospective cohort study. All adult patients on chronic hemodialysis who were admitted at PGH after the diagnosis of COVID-19 by RT-PCR between March 2020 and February 2021 were included. Patients who were asymptomatic for COVID-19, whose charts could not be retrieved, whose COVID-19 RT-PCR results were missing and those who died or got discharged without having a negative COVID-19 RT-PCR result were excluded in this study. Descriptive statistics were used in summarizing the data. Time to negative conversion is the primary outcome measure.

RESULTS
A total of 90 patients who were on chronic hemodialysis and tested positive for COVID-19 via RT-PCR admitted at PGH at the specified time period met the inclusion and exclusion criteria. A total of 60% were males and the median age was 55 years old. The mean HD vintage was 2.95 years. Among the causes of ESKD, 46% was from hypertension, 31% was due to diabetes mellitus, 15% due to chronic hemodialysis, 0.80% was caused by autosomal polycystic kidney disease, 2.50% was due to obstructive uropathy and the remaining 4.0% of patients with ESKD were due to other causes such as NSAID nephropathy, gouty nephropathy, etc. Of these, 17% had mild, 53% had moderate, 18% had severe and 12% had critical COVID-19. The mean number of days from the onset of symptoms to clinical recovery is 22.48 days; the median was 18 days. One patient had clinical recovery only after 84 days. The median time to first negative conversion was 24.5 days, with a mean of 26.65 days. There were 6.67% who achieved negative conversion on the first week; 15.56% on the second week; 24.44% on the third week; 26.67% on the fourth week; 8.89% on the fifth week; 6.67% on the sixth week; 4.44% on the seventh week; 5.56% on the eighth week; and 1.11% on the ninth week. After 28 days, 90% of the patients had clinical recovery, but 15% of them still had positive RT-PCR results.

CONCLUSION
Among adult patients on chronic hemodialysis who were admitted at PGH after the diagnosis of COVID-19 by RT-PCR between March 2020 and February 2021, the median time to negative conversion was 24.5 days.