The Effect of the COVID-19 Pandemic Process on Regular Follow-Up Chronic Kidney Disease Patients/ COVID-19 Pandemi Sürecinin Düzenli Takipte Olan Kronik Böbrek Hastalarına Etkisi

Yıl 2023, Cilt: 18 Sayı: 1, 22 - 30, 31.01.2023

Emine Asar , Feyza Bora

https://doi.org/10.47565/ndthdt.2023.64

Öz

Objective: We aimed to evaluate the follow-up status and laboratory results of the patients, who came to their regular follow-ups, had treatment compliance, and received low clearance training in 2019, the first year of the COVID-19 pandemic.
Materials-Methods: For the population of the study, the files of 432 patients, aged 18 years and older, were retrospectively investigated in the nephrology low clearance outpatient clinic, where the study was conducted. 165 patients who were followed up in the low clearance outpatient clinic before January 1, 2019, and who came to their follow-up and treatment regularly in 2019, were identified. Descriptive statistical methods, and parametric tests were used in the statistical analysis of the research data, Mann Whitney U test was used in the comparison of two independent groups, and Kruskal Wallis was used in the comparison of three or more independent groups.
Results: 142 patients, 59 (41.5%) female and 83 (58.5%) male patients were included. The mean age was 60.7 (min:21- max:94). When the patient's status of coming to routine controls is evaluated; it was determined that there were 64 patients (45.1%) who came regularly during one year, 50 (35.2%) patients who came irregularly, 28 (19.7%) patients who never came and who came after being called by phone. When the patients were divided into three groups according to the stage of coming to the nephrology outpatient clinic for routine control, no statistically significant difference was found in terms of gender and location. When separated by age groups, it was found that patients over the age of 65 had a higher rate of never coming. (p: 0.011). In the first year of the pandemic, 20 (71.4%) of 28 patients who never came to our outpatient clinic and 44 (88%) of 50 patients who came irregularly declared that they did not go to any health institution. The decrease in estimated Glomerular Filtration Rate (eGFR), increase in creatinine, and increase in proteinuria at the end of the first year of COVID-19 were interpreted as normal progression of CKD. At the end of one year, a statistically significant difference in albumin, potassium, bicarbonate, vitamin D, CRP, and PTH values was detected (p <0.05).
Conclusion: Routine medical care was interrupted during the pandemic. We have determined that the patients, who have repeatedly received the necessary information and training with their disease, managed to protect themselves in the first year of the COVID-19 pandemic and were not adversely affected. Standardization and widespread use of low-clearance outpatient training throughout the country will also be protective and effective in possible health system access problems.

Anahtar Kelimeler

COVID- 19, Chronic Kidney Disease, Nursing, Education

COVID-19 Pandemi Sürecinin Düzenli Takipte Olan Kronik Böbrek Hastalarına Etkisi/ The Effect of the COVID-19 Pandemic Process on Regular Follow-Up Chronic Kidney Disease Patients

Öz

Amaç: Bu çalışmada, 2019 yılında düzenli takiplerine gelen, tedavi uyumu olan ve düşük klirens eğitimlerini almış olan hastaların; COVID-19 pandemisinin birinci yılında takip durumlarını ve laboratuvar sonuçlarını değerlendirme amaçlandı.
Gereç-Yöntem: Araştırmanın evreni için, çalışmanın yürütüldüğü nefroloji düşük klirens polikliniğinde 18 yaş ve üzeri 432 hasta dosyası retrospektif olarak tarandı. 1 Ocak 2019 tarihinden önce düşük klirens polikliniğinde takibe alınmış, 2019 yılı içinde takip ve tedavilerine düzenli gelmiş olan 165 hasta tespit edildi. Araştırma verilerinin istatistiksel analizinde tanımlayıcı istatistiksel yöntemler, parametrik testler bağımsız iki grubun karşılaştırılmasında Mann Whitney U testi, bağımsız üç ve daha fazla grubun karşılaştırılmasında Kruskal Wallis testi kullanılmıştır.
Bulgular: Çalışmaya; 59 (%41,5) kadın, 83 (%58,5) erkek 142 hasta dahil edildi. Yaş ortalaması 60,7 (min:21-max:94) idi. Hastanın rutin kontrollerine gelme durumu değerlendirildiğinde; bir yıl süresince düzenli gelen 64 (%45,1) hasta, düzensiz gelen 50 (%35,2) hasta, hiç gelmeyen ve telefon ile çağırıldıktan sonra gelen 28 (%19,7) hasta olduğu tespit edildi. Hastaların evrelerine göre nefroloji polikliniğine rutin kontrole gelme konusunda üç gruba ayrıldığında cinsiyet ve yerleşim yeri konusunda istatistiksel olarak anlamlı fark saptanmadı. Yaş gruplarına göre ayrıldığında 65 yaş üstü hastaların hiç gelmeme oranlarının daha yüksek olduğu tespit edildi (p: 0,011). Pandeminin ilk yılı içinde, polikliniğimize hiç gelmeyen 28 hastanın 20 (%71,4)’si ve düzensiz gelen 50 hastanın 44 (%88)’ü hiçbir sağlık kuruluşuna gitmediğini beyan etti. Hastaları COVID-19 birinci yıl sonunda tahmini glomerüler filtrasyon hızında (tGFH) düşüş, kreatinin değerinde artış olması, proteinüride artış olması KBH’nın normal progresyonu olarak yorumlandı. Hastaların bir yıl sonunda albümin, potasyum, bikarbonat, vitamin D, CRP, PTH değerlerinde istatistiksel olarak anlamlı fark tespit edildi (p<0,05).
Sonuç: Pandemi sırasında rutin tıbbi bakım kesintiye uğradı. Hastalığı ile gerekli bilgilendirme ve eğitimlerini tekrar tekrar almış olan hastaların COVID-19 pandemisi birinci yılında olumsuz etkilenmediklerini tespit edildi. Düşük klirens polikliniği eğitimlerinin standardize edilip ülke genelinde yaygın bir şekilde kullanılması olası sağlık sistemine ulaşım sorunlarında da koruyucu ve etkili olacaktır.

Anahtar Kelimeler

Kronik Böbrek Hastalığı, COVID- 19, Eğitim, Hemşire

Kaynakça

• 1. Van den Bosch J, Warren DS, Rutherford PA. Review of predialysis education programs: a need for standardization. Patient Preference and Adherence. 2015;9:1279-91. doi: 10.2147/PPA.S81284.
• 2. Goovaerts T, Bagnis Isnard C, Crepaldi C, Dean J, Melander S, Moone A, et al. Continuing education: preparing patients to choose a renal replacement therapy. Journal of Renal Care. 2015; 41(1): 62-75. DOI: 10.1111/jorc.12106.
• 3. Asar E, Bora F, Erol A, Şanlı T, Bozkurt N, Çetinkaya R ve ark. Nefroloji düşük klirens polikliniğinde hasta eğitim süreci: olgu sunumu. Nefroloji Hemşireliği Dergisi. 2019; 14(1): 33-43.
• 4. World Health Organization Coronavirus disease 2019 (COVID-19) Weekly epidemiological update - 4 May 2021. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-COVID-19. 4-may-2021 Accessed July 5, 2021.
• 5. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. China medical treatment expert group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. The New England Journal Medice. 2020;382(18):1708–1720.
• 6. Cubuk J, Alston JJ, Incicco JJ, Singh S, Stuchell-Brereton MD, Ward MD, et al. The SARS-CoV-2 nucleocapsid protein is dynamic, disordered, and phase separates with RNA. Nature Communication. 2021;12(1):1936. https://doi.org/10.1038/s41467-021-21953-3
• 7. Nooraei S, Bahrulolum H, Hoseini ZS, Katalani C, Hajizade A , Easton AJ, et al. Viruslike particles: preparation, immunogenicity and their roles as nanovaccines and drug nanocarriers. Journal of Nanobiotechnology. 2021;19(1):59. https://doi.org/10.1186/s12951-021-00806-7
• 8. Machida S, Shibagaki Y, Sakurada T. An inpatient educational program for chronic kidney disease. Clinical and Experimental Nephrology. 2019; 23(4): 493-500. doi: 10.1007/s10157-018-1660-5.
• 9. Marks A, Fluck N, Prescott GJ, Robertson LM, Simpson WG, Smith WCS, et al. Definitions of progression in chronic kidney disease—predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up. Nephrology Dialysis Transplantation. 2014; 29(2):333-341. doi: 10.1093/ndt/gft393.
• 10. Babel N, Hugo C. Westhoff TH. Vaccination in patients with kidney failure: lessons from COVID-19. Nature Reviews Nephrology. 2022;18(11):708-723. DOI: 10.1038/s41581-022-00617-5.
• 11. D'Marco L, Puchades MJ, Romero-Parra M, Gimenez-Civera E, Soler MJ, Ortiz A, et al. Coronavirus disease 2019 in chronic kidney disease. Clinical Kidney Journal. 2020;13(3): 297-306.
• 12. Kissler SM, Tedijanto C, Goldstein E, Grad YH, Lipsitch M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science. 2020;368:860–868. DOI: 10.1126/science.abb5793
• 13. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID- 19. Kidney Internationl. 2020;97:829–838. doi: 10.1016/j.kint.2020.03.005.
• 14. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan.The Journal of Allergy Clinical Immunology. 2020;146 (1):110–118. doi: 10.1016/j.jaci.2020.04.006.
• 15. Fang X, Li S, Yu H, Wang P, Zhang Y, Chen Z, et al. Epidemiological, comorbidity factors with severity and prognosis of COVID19: a systematic review and metaanalysis. Aging (Albany NY). 2020; 12(13):12493-12503 doi: 10.18632/aging.103579.
• 16. Henry B, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. International Urology and Nephrology. 2020;52:1193–1194. doi: 10.1007/s11255-020-02451-9.
• 17. Shi L, Lu Z, Que J, Huang XL, Liu L, Ran MS, et al. Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic. JAMA Network Open. 2020;3(7):1–16. doi: 10.1001/jamanetworkopen.2020.14053.
• 18. Hu S, Tucker L, Wu C, Yang L. Beneficial effects of exercise on depression and anxiety during the COVID-19 pandemic: A narrative review. Frontiers in Psychiatry.2020; 11: 1217. doi: 10.3389/fpsyt.2020.587557.
• 19. Macit MS. COVID-19 salgını sonrası yetişkin bireylerin beslenme alışkanlıklarındaki değişikliklerin değerlendirilmesi. Mersin Üniversitesi Sağlık Bilimleri Dergisi.2020; 13(3): 277-288. https://doi.org/10.26559/mersinsbd.769698.
• 20. Dilber A, Dilber F. Koronavirüs (COVID-19) salgınının bireylerin beslenme alışkanlıkları üzerindeki. Journal of Tourism and Gastronomy Studies. 2020; 8(3): 2144-2162. DOI: 10.21325/jotags.2020.653
• 21. Konttinen H. Emotional eating and obesity in adults: the role of depression, sleep and genes. Proc Nutr Soc. 2020;79(3):283- 289. doi: 10.1017/S0029665120000166.
• 22. Cheng SH, Kamil MKM. Stress and food intake among university students - is there a relationship?. Sains Malaysiana. 2020; 49(1): 121-128. http://dx.doi.org/10.17576/jsm-2020-4901-14
• 23. Jayne JM, Ayala R, Karl JP, Deschamps BA, McGraw SM, et al. Body weight status, perceived stress, and emotional eating among US Army Soldiers: A mediator model. Eating Behaviours. 2020;36:101367. doi: 10.1016/j.eatbeh.2020.101367
• 24. Chen G, Zhou Y, Xia J, Yao J, Zheng K, Qin Y, et al. When the COVID-19 pandemic changed the follow-up landscape of chronic kidney disease: a survey of real-world nephrology practice. Renal Failure.2020; 42(1): 733-739. doi: 10.1080/0886022X.2020.1798783.