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- Cardiology Research Center, Heart Hospital, Hamad Medical Corporation, Doha, Qatar [1]
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Risk factors associated with chronic kidney disease progression: Long-term retrospective analysis from Qatar
Introduction: The risk factors influencing the natural course of chronic kidney disease (CKD) are complex and heterogeneous. Recognizing the factors associated with CKD progression can enable the identification of high-risk patients for more intensive treatment.
Patients and methods: A retrospective evaluation of CKD patients was performed under follow-up between January 1 2001 and December 31 2016 at a tertiary health care center.
Results: Among 5370 screened patients 1020 patients with complete data were included in the analysis. The median follow-up period for the studied patients was 9.3 years. Based on the analysis 120 (11.8%) patients had reached end-stage kidney disease “ESKD” or death. The study revealed that the risk factors associated with reaching ESKD and/or death using Kaplan–Meier survival curve and log rank test included higher hemoglobin A1c among diabetic patients higher grade of proteinuria and non use of renin-angiotensin system blockers. The patients with CKD progression constituted 77.2% of all CKD patients. The study findings indicated that older age Arab ethnicity smoking habit diabetes mellitus and hypertension (presumed as original kidney diseases) are among the significant risk factors associated with a further decline of the estimated glomerular filtration rate (eGFR) and further CKD progression.
Conclusion: This study summarized the demographic and clinical risk factors associated with CKD progression and patients’ outcomes among a unique and heterogeneous population in the state of Qatar. Intensive treatment of modifiable risk factors could be of value in halting the progression of CKD. However prospective studies are warranted to confirm our findings.
Prevalence of coronavirus disease 2019 in a multiethnic cohort of patients with autoimmune rheumatic diseases in Qatar
Background: Autoimmune rheumatic diseases (ARDs) are characterized by immune dysfunction and associated with an increased risk of infections which were of significant concern during the coronavirus disease 2019 (COVID-19) pandemic. Variable rates of COVID-19 incidence have been reported in patients with ARDs; however the true effect of this infection on this patient population is still unclear. We therefore aimed to evaluate the COVID-19 prevalence among a multiethnic cohort of patients with ARDs in Qatar.
Material and Methods: We used telephonic surveys to collect demographic and clinical information of patients with ARD in Qatar between April 1 and July 31 2020 including any close contact with a COVID-19 case at home or work and polymerase chain reaction (PCR)-confirmed COVID-19 diagnosis. An electronic medical records review was conducted to verify pertinent data collected through the surveys. Prevalence with 95% confidence interval (CI) Student's t-tests and chi-square/Fisher's exact tests were used for univariate analyses whereas multivariate logistic regression was used to identify factors associated with COVID-19.
Results: The study included 700 patients with ARD (mean age 43.2 ± 12.3 years) and 73% were female. Until July 2020 75 (11% 95% CI 9%–13%) patients had COVID-19. Factors associated with COVID-19 included being a man (adjusted odds ratio [aOR] 2.56 95% CI 1.35–4.88 p = 0.01) and having close contact with a COVID-19 case (aOR 27.89 95% CI 14.85–52.38 p = 0.01). Disease severity and rheumatic medications had no significant association with the odds of contracting COVID-19. In the 86 patients with ARD having close contact the frequency of hydroxychloroquine utilization was lower in patients who contracted COVID-19 than in those who did not (35% vs 72.5% p = 0.01).
Conclusions: In Qatar patients with ARDs had an overall higher prevalence of COVID-19 than global estimates. Being male and having close contact with a COVID-19 case were strongly associated with COVID-19 as reported globally. The presence of comorbid conditions disease-specific factors and rheumatic medications had no significant effect on the risk of COVID-19 in our study suggesting alternative mechanisms to the increased prevalence.
National response to the COVID-19 Omicron variant crisis in the ambulatory hemodialysis service in the State of Qatar
The coronavirus disease (COVID-19) pandemic has had a significant worldwide impact since its emergence in 2019. End-stage kidney disease patients have been among the most vulnerable population affected and have a higher risk of acquiring infection and developing more severe disease. We have encountered three major COVID-19 waves in Qatar and they have required different strategies to overcome. The most recent wave was due to the Omicron variant characterized by higher transmissibility. The monthly incidence of COVID-19 infection during the Omicron wave in patients with end-stage renal disease peaked at 256 patients compared to 35 and 39 patients during the first and second waves respectively. In addition more than one-third of our dialysis staff became infected during this wave. Unlike the previous two waves COVID-19 due to the Omicron variant was less severe with only 5% of hemodialysis patients requiring admission to the intensive care unit compared to 25% during the previous waves. The Omicron variant wave resulted in a crisis in our country due to the high number of non-hospitalized COVID-19 hemodialysis patients and the severe staff shortage. Several measures were taken to overcome the crisis such as designating one facility to dialyze all COVID-19 ambulatory patients reducing dialysis sessions to 3 hours and introducing a fourth dialysis shift.
This article describes the challenges we faced in the ambulatory hemodialysis service during the Omicron wave and the measures taken in the COVID-19 and non-COVID-19 designated facilities to combat the crisis.