COVİD-19 Geçiren Böbrek Nakli Alıcılarında Telesağlık İzlemi: Retrospektif Çalışma

Amaç: COVID-19 pozitif saptanan ve tele sağlık hizmetleri aracılığıyla takip edilen böbrek nakli alıcılarının özelliklerini, hospitalizasyon ihtiyacını, klinik seyrini, durumun ciddiyetini, tedavi yönetimi hakkında bilgileri anket yolu ile retrospektif olarak incelemektir. Gereç Yöntem: Tanımlayıcı ve retrospektif türde olan bu çalışmanın evrenini bir üniversite hastanesinin Organ Nakli Merkezinde Mart 2020 – Mart 2021 tarihleri arasında COVID-19 pozitif olan, telesağlık hizmetleri aracılığıyla takip edilen 18 yaş üstü böbrek nakli alıcıları oluşturdu. Araştırmada örneklem seçim yöntemi kullanılmadan veri toplama tarihleri arasında telesağlık hizmeti aracılığıyla takip edilen tüm hastalar araştırma kapsamına alındı. Araştırmanın örneklemini 18 yaşını doldurmuş, COVID-19 pozitif saptanan 63 böbrek nakli alıcısı oluşturdu. Veriler, araştırmacılar tarafından hazırlanan anket formu ile tıbbi kayıtların retrospektif olarak incelenmesiyle ve hastalar ile gerçekleştirilen telefon görüşmeleri ile elde edildi. Araştırmadan elde edilen veriler tanımlayıcı istatistiksel yöntemlerle değerlendirildi. Araştırma için araştırmanın yapıldığı kurumun Klinik Araştırmalar Etik Kurulundan onay alındı. Bulgular: COVID-19 pozitif saptanan böbrek nakli alıcılarının yaş ortalamasının 50,70±10,89 olduğu, beden kitle indeksi ortalamasının 27,71±6,20 olduğu ve hastaların %23,8’inin obes olduğu, %52,4’ünün erkek olduğu, %60,3’ünün ilköğretim mezunu olduğu, %81’inin ek hastalığının olduğu (%84,1’inde hipertansiyon, %22,2’sinde diyabet), %52,4’ünün canlıdan nakil olduğu belirlendi. Böbrek nakli alıcılarının %52,4’ünün sonbaharda hastalığa yakalandığı, %49,2’sinde öksürük, %42,9’unda pnömoni, %42,9’unda genel vücut ağrısı/yorgunluk, %22,2’sinde dispne, %22,2’sinde tat ve koku kaybı, %11,1’inde baş ağrısı, %15,9’unda ishal, %9,5’inde bulantı kusma belirtileri olduğu saptandı. %42,9’unda torax CT tutulumu vardı, hastaların %44,4’ü hastaneye yatarak tedavi olduğu, %17,5’i yoğun bakımda tedavi aldığı, %6,3’ünün entübe edildiği, %15,9’u rejeksiyon riski yaşadığı, %7,9’unun ex olduğu, %1,6’sının hemodiyalize başladığı belirlendi. Sonuç: Organ nakli hastalarında COVID-19 teşhisi genel popülasyona benzer olmasına rağmen, semptomların hafif seyredip hastalığın hızlı ilerleyebildiği ve sağlıklı popülasyona göre mortalitenin yüksek seyrettiği görüldü.

Anahtar Kelimeler:

Covid 19, Böbrek Nakli, Tele sağlık

Telehelath Monitoring in Renal Transplantat Recipients with Diagnosis COVID-19: Retrospective Study

Objective: To retrospectively examine the characteristics, hospitalization need, clinical course, severity of the condition and information about treatment management of kidney transplant recipients who were found to be COVID-19 positive and followed up through Telehealth services, through a questionnaire. Methods: The population of this descriptive and retrospective study consisted of kidney transplant recipients over the age of 18 who were followed up through Telehealth services, who were positive for COVID-19 in the Organ Transplant Center of a university hospital between March 2020 and March 2021. In the study, all patients followed up via Telehealth service between the data collection dates without using the sample selection method were included in the study. The sample of the study consisted of 63 kidney transplant recipients over the age of 18 who were found to be positive for COVID-19. The data were obtained by retrospective examination of medical records with a questionnaire prepared by the researchers and telephone interviews with patients. The data obtained from the study were evaluated by descriptive statistical methods. Approval for the study was obtained from the Clinical Research Ethics Committee of the institution where the study was conducted. Results: The mean age of kidney transplant recipients who were found to be positive for COVID-19 was 50.70±10.89, the mean body mass index was 27.71±6.20, and 23.8% of the patients were obese, 52.4% were male. It was determined that 60.3% of them were primary school graduates, 81% had comorbidities (84.1% hypertension, 22.2% diabetes), 52.4% of them were transplanted from a living donor. It was determined that 52.4% got the disease in autumn, 49.2% had cough, 42.9% had pneumonia, 42.9% had general body pain/fatigue, 22.2% dyspnea, 22.2% loss of taste and smell, 11.1% headache, 15.9% diarrhea, 9.5% nausea and vomiting symptoms were found. 42.9% had thorax CT involvement, 44.4% of the patients were hospitalized, 17.5% were treated in the intensive care unit, 6.3% were intubated, 15.9% experienced rejection risk, 7.9% died, 1.6% started hemodialysis. Conclusion: Although the diagnosis of COVID-19 in organ transplant patients was similar to the general population, it was observed that the symptoms were mild and the disease progressed rapidly, and the morbidity and mortality were high. For this reason, it is necessary to be careful and attentive in the diagnosis, treatment and nursing care of organ transplant patients.

Keywords:

Covid-19, Kidney Transplantation, Tele health,

PDF

___

American Medical Association. (2020). Telehealth Implementation Playbook. Digital Health Implementation Playbook Series. https://www.ama-assn.org/system/files/2020-04/ama-telehealth-playbook.pdf (accessed July 22, 2020).
Androga, L.A., Amundson, R.H., Hickson, L.J., Thorsteinsdottir, B., Garovic, V.D., Manohar, S., et al. (2022) Telehealth versus face-to-face visits: A comprehensive outpatient perspective-based cohort study of patients with kidney disease. PLoS ONE, 17(3), e0265073. https://doi.org/10.1371/journal.pone.0265073
Azzi, Y., Parides, M., Alani, O., Loarte-Campos, P., Bartash, R., Forest, S., Colovai, A., Ajaimy, M., Liriano-Ward, L., Pynadath, C., Graham, J., Le, M., Greenstein, S., Rocca, J., Kinkhabwala, M., Akalin, E.(2020). COVID-19 infection in kidney transplant recipients at the epicenter of pandemics. Kidney International, 98, 1559–1567.
Boyarsky, B.J., Po-Yu Chiang, T., Werbel, W.A., Durand, C.M., Avery, R.K., Getsin, S.N., Jackson, K.R., Kernodle, A.B., Van Pilsum Rasmussen, S.E., Massie, A.B., Segev, D.L., Garonzik-Wang, JM.(2020). Early impact of COVID-19 on transplant center practices and policies in the United States. Am J Transplant. 20(7), 1809-1818. https://doi.org/10.1111/ajt.15915
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) webpage – Healthcare Workers. “Using telehealth to expand access to essential health services during COVID-19 pandemic.” Updated June 10, 2020.
Chang, J.H., Diop, M., Burgos, Y., et al. (2020).Telehealth in outpatient management of kidney transplant recipients during COVID-19 pandemic in New York. Clin Transplant, 34(12), e14097.
Chang, J.H., Sritharan, S., Schmitt, K., Patel, S., Crew, J., Tsapepas, D.S.(2021). Home Care Delivery and Remote Patient Monitoring of Kidney Transplant Recipients During COVID-19 Pandemic. Progress in Transplantation, 31(4), 381-384. Gonzalez, J., Ciancio, G. (2020). Early experience with COVID-19 in kidney transplantation recipients: update and review. Int Braz J Urol, 46(1), 145-155. https://doi.org/10.1590/S1677-5538.IBJU.2020.S114
Husain, S. A., Dube, G., Morris, H., Fernandez, H., Chang, J. H., Paget, K., Sritharan, S., Patel, S., Pawliczak, O., Boehler, M., Tsapepas, D., Crew, R. J., Cohen, D. J., & Mohan, S. (2020). Early Outcomes of Outpatient Management of Kidney Transplant Recipients with Coronavirus Disease 2019. Clinical journal of the American Society of Nephrology : CJASN, 15(8), 1174–1178. https://doi.org/10.2215/CJN.05170420
Jittirat, A., Eguchi, N., Tanphaichitr, N., Tomas, M., Gundelly, P., Zhao, K., Herlitz, L., Chalicheemala, Y., Yerneni, H. Forbes, R.C., Concepcion, B.P., Tantisattamo, E.(2022). Kidney Transplantation during the COVID-19 Pandemic: From Past through Present Time of Emerging Vaccine. OBM Integrative and Complementary Medicine, 7(1), 29
Kataria, A., Yakubu, I., Winstead, R., Gowda, M., & Gupta, G. (2020). COVID-19 in Kidney Transplantation: Epidemiology, Management Considerations, and the Impact on Kidney Transplant Practice. Transplantation direct, 6(8), e582. https://doi.org/10.1097/TXD.0000000000001031
Kurt, H.A., Alan, C., Demirci, E. (2020). COVID-19 ve böbrek nakli. Gürbüz R, editör. Üroloji ve COVID-19. 1. Baskı. Ankara: Türkiye Klinikleri; p.40-4.
Ladin, K., Porteny, T., Perugini, J. M., Gonzales, K. M., Aufort, K. E., Levine, S. K., Wong, J. B., Isakova, T., Rifkin, D., Gordon, E. J., Rossi, A., Koch-Weser, S., & Weiner, D. E. (2021). Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians. JAMA network open, 4(12), e2137193. https://doi.org/10.1001/jamanetworkopen.2021.37193
Mann, D. M., Chen, J., Chunara, R., Testa, P. A., & Nov, O. (2020). COVID-19 transforms health care through telemedicine: Evidence from the field. Journal of the American Medical Informatics Association : JAMIA, 27(7), 1132–1135. https://doi.org/10.1093/jamia/ocaa072
O'Keefe, J. B., Tong, E. J., O'Keefe, G. D., & Tong, D. C. (2021). Description of symptom course in a telemedicine monitoring clinic for acute symptomatic COVID-19: a retrospective cohort study. BMJ open, 11(3), e044154. https://doi.org/10.1136/bmjopen-2020-044154
Özşaker E. (2021). Böbrek Nakli: Covid-19 Etkisi, Van Sag Bil Derg, 14(3), 352- 360. https://doi.org/10.52976/vansaglik.944910.
Papalois, V., Kotton, C. N., Budde, K., Torre-Cisneros, J., Croce, D., Halleck, F., Roze, S., & Grossi, P. (2022). Impact of COVID-19 on Global Kidney Transplantation Service Delivery: Interim Report. Transplant international : official journal of the European Society for Organ Transplantation, 35, 10302. https://doi.org/10.3389/ti.2022.10302
Rivinius, R., Kaya, Z., Schramm, R., Boeken, U., Provaznik, Z., Heim, C., Knosalla, C., Schoenrath, F., Rieth, A., Berchtold-Herz, M., Barten, M. J., Rauschning, D., Mücke, V. T., Heyl, S., Pistulli, R., Grinninger, C., Hagl, C., Gummert, J. F., Warnecke, G., Schulze, P. C., … Raake, P. W. (2020). COVID-19 among heart transplant recipients in Germany: a multicenter survey. Clinical research in cardiology : official journal of the German Cardiac Society, 109(12), 1531–1539. https://doi.org/10.1007/s00392-020-01722-w
Suárez-Gil, R.; Casariego-Vales, E.; Blanco-López, R.; Santos-Guerra, F.; Pedrosa-Fraga, C.; Fernández-Rial, Á.; Íñiguez-Vázquez, I.; Abad-García, M.M.; Bal-Alvaredo, M.; on behalf of the members of the Lugo TELEA-COVID Team. Efficacy of Telemedicine and At-Home Telemonitoring following Hospital Discharge in Patients with COVID-19. J. Pers. Med. 2022, 12, 609.
Usta O.(2020). COVID-19 pandemisinde ev izolasyonu ve temaslı takibi. Set T, editör. Aile Hekimliği ve COVID-19 Pandemisi. 1. Baskı. Ankara: Türkiye Klinikleri; p.25-9.
World Health Organization (2022). Coronavirus disease (COVID-19) pandemic. Last update: January 14, 2022, 09:03 AM GMT-8 [Internet]. Geneva, Switzerland: World Health Organization; [cited date 2022 January 16]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
Xu, H., Huang, S., Qiu, C., Liu, S., Deng, J., Jiao, B., Tan, X., Ai, L., Xiao, Y., Belliato, M., & Yan, L. (2020). Monitoring and Management of Home-Quarantined Patients With COVID-19 Using a WeChat-Based Telemedicine System: Retrospective Cohort Study. Journal of medical Internet research, 22(7), e19514. https://doi.org/10.2196/19514
Yılmaz, R.(2020). COVID-19 ve böbrek transplantasyonu. Ateş K, Arıcı M, editörler. Nefroloji ve COVID-19. 1. Baskı. Ankara: Türkiye Klinikleri, p.47-51.