Evaluation of the Impact of Local Protocol of King Salman Specialized Hospital-KSA of Management of Renal Disease patients requiring Immunosuppressive Therapy Afflicted by Acute COVID 19 Infection – an Observational Study

Aims: We aimed to observe the effect of modification of the immunosuppressive regimen in response to the severity of COVID-19 infection on the outcome of renal disease patients and to study factors affecting their mortality.

Methods and Materials: The study was conducted on 18 patients (13 males and 5 females) admitted to the King Salman Specialized hospital (KSSH), a COVID-19 isolation center, in Hail city in KSA; of them, 16 had kidney transplantation maintained on immunosuppression protocols, while 2 had immune-mediated nephritis maintained on immunosuppression. Locally agreed immunosuppressive protocol, the antivirals used as well as the used anticoagulant were followed without interference. Demographic data, associated comorbidities, baseline x-ray, routine laboratory data, and patients’ outcomes were recorded.

Results: The ages of the studied patients ranged from 23 - 60 years. Nine patients were treated in the ward (group 1) and the other 9 patients needed admission to the ICU (group 2). Compared to group 1, group 2 patients had higher mortality, higher levels of TLC, CRP, and serum phosphorus as well as admission LDH and D-dimer. Furthermore, group 2 patients had lower serum albumin, and lower blood platelet and lymphocyte counts. All patients continued on corticosteroids and calcineurin inhibitors in case they had been maintained on them before the infection. Antiproliferative drugs (MMF or Azathioprine) were discontinued in all patients; 15 of them stopped it on the first admission day and 3 were reluctant to stop the drugs till a few days later when they were admitted to the ICU. Of the total observed patients 4 died; 3 of them were those who did not stop these drugs early in the course of the disease.

Conclusions: Appropriately early discontinuation of antiproliferative drugs in renal immunosuppressed patients and the use of higher doses of systemic steroids were associated with better prognosis of COVID-19 infection patients and did not cause deterioration of kidney function.