COVID-19 in hemodialysis patients: a single-center experience in Istanbul

Abstract

Objective Coronavirus disease 2019 (COVID-19) causes a wide spectrum of symptoms, from asymptomatic conditions to severe inflammatory response. Hemodialysis (HD) patients have a higher risk for developing severe COVID-19 because of older age, multiple co-morbid conditions, and impaired immune system compared to the general population. As little is known about these special groups, we evaluated the clinical characteristics and outcomes of HD patients with COVID-19. Methods All hospitalized HD patients with COVID 19 between March 11, 2020 and May 31, 2020 were included in the study. The composite end-points consisted of admission to the intensive care unit (ICU), discharging or death were analysed. Demographic, clinical, laboratory, and treatment data were retrieved and compared between survivors and nonsurvivors. Results A total of 45 patients (median age 65.33 ± 12.22, 24 female, 53.96 ± 40.68) were enrolled and of whom 14 were admitted to ICU and overall 14 (31.1%) have died. Hypertension was the most common comorbidity and fever (60%), dyspnea (55.6%) and cough (53.3%) were predominant symptoms at admission. 8.8% of patients developed severe complications (acute respiratory distress syndrome, macrophage activation syndrome) and secondary infection was observed in 51.1% of the patients. Elevation in the level of inflammatory markers, lactate dehydrogenase, liver enzymes, troponin, creatine kinase, and decrease in lymphocyte count and serum albumin level were observed in non-survivors compared with survivors throughout the clinical course. No significant difference was observed in the score of chest CT performed on the day of hospitalization for the survivors and non-survivors. Conclusion Mortality of COVID-19 in HD patients is high and follow up of certain laboratory parameters can help to predict the prognosis of the patients.

Clinical Characteristics and Early Outcomes of Hospitalized COVID-19 Patients with End-Stage Kidney Disease in Saudi Arabia

“…19 These findings are consistent with those of previous studies, which have reported that elevated levels of inflammatory markers are associated with increased disease severity and worse outcomes, regardless of the immunosuppression observed in patients with ESKD. [7][8][9][10] An increase in serum ferritin levels was observed in the deceased patients in the present study. This finding may be confirmed by the presence of severe inflammation, as ferritin is a positive acute-phase protein.…”

“…Furthermore, the mortality rate was high (20%) in the present study; however, this rate is lower than that reported in New York (28%), Manila (25%), and Istanbul (31%). [7][8][9] In the present study, most hospitalized COVID-19 patients with ESKD were aged ≥ 65 years and had two or more pre-existing comorbidities, such as hypertension, diabetes, and cardiovascular disease, which are common in patients with ESKD and are associated with increased disease severity and mortality risk. 4,5,15 We found that the mortality risk in COVID-19 patients with ESKD and cardiovascular disease was fourfold higher than that in the others.…”

“…These results are in line with those of previous studies. [7][8][9] The laboratory findings were predictive of severe COVID-19 symptoms and the risk of early mortality. A study conducted in Wuhan hypothesized that patients with ESKD are incapable of mounting a robust immune response that may lead to cytokine storm syndrome, which is associated with increased disease severity and mortality.…”

“…To our knowledge, very few published papers have reported the clinical outcomes of COVID-19 and its effects on ESKD. [7][8][9][10] However, there is a need to increase the available evidence in this regard, particularly in Saudi Arabia, owing to genetic and ethnic differences among the populations. In addition, the clinical characteristics of COVID-19 patients with ESKD in Jazan Province, Saudi Arabia, have not been evaluated so far.…”

Capacidad de respuesta inmunitaria al COVID-19 en pacientes en hemodiálisis

“…La incidencia descrita en otras Unidades de Hemodiálisis varía entre el 20 y 40%, según el momento de la pandemia [11,12]. La tasa de ingreso por enfermedad grave ascendió al 50%, porcentaje similar al encontrado en otras cohortes [12,13], lo que confirma los datos descritos en estudios sobre los factores asociados al desarrollo de COVID-19 grave y la vulnerabilidad de los pacientes en TRS [14,15]. Los datos recogidos en el último registro de la Sociedad Española de Nefrología (SEN), describen una mortalidad total de la pandemia del 21% en la población de TRS contagiada por COVID-19, mortalidad que asciende al 30% en los pacientes en hemodiálisis [16].…”