الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
COVID-19 is an emerging infectious disease affecting respiratory system caused by SARS-CoV2 virus that was first isolated in December 2019 in Wuhan city, China. It was declared as a global pandemic by the WHO in March 2020 due to rapid spread and increasing number of deaths every day. Within two years more than 400 million people were affected with a worldwide CRF 1.4%.
The current COVID-19 situation has resulted in disruptions in the social, economic and health care system throughout the world. Lock down have been implemented and campaigns of “Stay home, stay safe” and adopting social distancing on the social media were performed extensively to increase the public awareness of COVID-19 symptoms and preventive measures.
Clinical presentations vary from asymptomatic or mild non-specific symptoms to acute respiratory distress syndrome (ARDS). Many studies found that severe and critical presentations usually occur in old age and patients have associated comorbidities e.g., hypertension, diabetes, CV diseases, chronic pulmonary diseases as well as CKD.
The high incidence and prevalence of CKD and ESRD is a global challenge. The prevalence of CKD in the United States population is 14.8%, while the prevalence of ESRD is 2160 per million. CKD patients are usually old age and have many comorbidities associated with significantly increased morbidity and mortality including CVD, diabetes, hypertension, anemia, and mineral and bone disease. They are more vulnerable to infection due to immune cell dysfunction. Along with infections these comorbidities represent the main causes of hospital admission in ESRD.
COVID-19 pandemic represents a special threat for patients having ESRD and maintained on HD not only for high viral morbidity and mortality but also it can affect quality of care and result in high psychological and economic burden. HD patients have to stay in close contact during HD sessions, so many patients may miss HD sessions for the fear of infection. Some HD units decreased the duration of HD sessions to apply screening and disinfection protocols. Shortages of health professionals who are debuted in isolation hospitals and had self-quarantine with exposure to COVID-19 cases can affect the quality of provided care. Routine follow-up of comorbidities, labs, elective procedures was postponed. Relying on public transportation during lockdown periods add an exposure risk and can affect accessibility to HD units, outpatient, and inpatient services.
The aim of this study is to report the incidence and outcomes of COVID-19 infection in HD patients in Alexandria, Egypt and to compare the HD adequacy parameters, hospital admissions and all-cause mortality 10 months before and during the first 10 months of the COVID-19 pandemic.
This is a retrospective cohort including all adult HD patients from 5 HD units including El Mowasah University Hospital, Alexandria University Student Hospital, Smouha University Hospital, Abu-Quir General Hospital and Kidney and Urology Centre. We reported the incidence of COVID-19 infection in HD patients during the period from March 2020 till December 2020 according to the WHO diagnostic criteria published in March 2020. Relevant variables about HD adequacy during the period from June 2019 till December 2020 were collected.