COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia emerged in Wuhan, China in December 2019. Unfortunately, there is a lack of evidence about the optimal management of novel coronavirus disease 2019 (COVID-19), and even less is available in patients on maintenance hemodialysis therapy than in the general population. In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of all maintenance hemodialysis patients hospitalized with COVID-19 from March 12th to April 10th, 2020 as confirmed by real-time polymerase chain reaction. Baseline features, clinical course, laboratory data, and different therapies were compared between survivors and nonsurvivors to identify risk factors associated with mortality. Among the 36 patients, 11 (30.5%) died, and 7 were able to be discharged within the observation period. Clinical and radiological evolution during the first week of admission were predictive of mortality. Among the 36 patients, 18 had worsening of their clinical status, as defined by severe hypoxia with oxygen therapy requirements greater than 4 L/min and radiological worsening. Significantly, 11 of those 18 patients (61.1%) died. None of the classical cardiovascular risk factors in the general population were associated with higher mortality. Compared to survivors, nonsurvivors had significantly longer dialysis vintage, increased lactate dehydrogenase (490 U/l ± 120 U/l vs. 281 U/l ± 151 U/l, P [ 0.008) and C-reactive protein levels (18.3 mg/dl ± 13.7 mg/dl vs. 8.1 mg/dl ± 8.1 mg/dl, P [ 0.021), and a lower lymphocyte count (0.38 310 3 /ml ± 0.14 310 3 /ml vs. 0.76 310 3 /ml ± 0.48 310 3 /ml, P [ 0.04) 1 week after clinical onset. Thus, the mortality among hospitalized hemodialysis patients diagnosed with COVID-19 is high. Certain laboratory tests can be used to predict a worsening clinical course.

Management and Outcomes of patients on maintenance dialysis during the COVID-19 pandemic: a report from Geneva, Switzerland

“…Few reports have recently been published on dialysis units ongoing experience during the COVID-19 outbreak. They provide epidemiological data on infection and mortality rates within their dialysis population [14][15][16][17] .…”

The reliability and success of peritoneal dialysis during the COVID-19 pandemic

“…These limitations combined with older age, impaired immune system, and multiple comorbid conditions resulted in increased mortality. In the literature, the mortality rate of patients with maintenance center hemodialysis due to COVID-19 was reported to be between 16% and 30% 4,5 .…”

“…One of these frail groups consisted of patients with end-stage kidney disease (ESRD). Patients on maintenance dialysis are likely to have an increased risk of COVID-19 and its complications due to older age, multiple comorbid conditions, and a suppressed immune system 1,2,4 . Additionally, the need for travel thrice weekly to the dialysis center, clustering of patients in dialysis units, and contact of dialysis staff members for more than one patient also restricts the physical isolation of hemodialysis patients, which is necessary for protection from the virus.…”

Nephrology and Coronavirus Disease 2019

“…Reports from Spain and Italy found high mortality rates (30.5 and 25%, respectively) in ESRD patients with COVID-19. 27,28 Dialysis vintage, lymphopenia, and increased lactate dehydrogenase at admission were predictors of mortality. 27 Of note, three (8.3%) patients had documented nosocomial transmission.…”