COVID-19 in Patients Undergoing Hemodialysis: Prevalence and Asymptomatic Screening During a Period of High Community Prevalence in a Large Paris Center

Créput, Caroline; Fumeron, Christine; Toledano, Daniel; Diaconita, Mirela; Izzedine, Hassan

doi:10.1016/j.xkme.2020.09.001

Cited by 35 publications

(51 citation statements)

References 21 publications

(21 reference statements)

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“…The symptomatology described is consistent with several worldwide reports. Fever is the most frequent symptom, followed by dry cough, dyspnea and to a lesser degree diarrhea [30,28,23,31]. The rst reports of COVID-19 in dialysis emphasized the frequency of diarrhea [3] but it was not con rmed in larger samples.…”

Section: Discussionmentioning

confidence: 99%

Age and Multimorbidities as Poor Prognostic Factors for COVID-19 in Hemodialysis: a Lebanese National Study

Aoun

Khalil

Mahfoud³

et al. 2020

Preprint

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BackgroundHemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients.MethodsThis is a cross-sectional study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients' medical records. A binary logistic regression analysis was performed to assess risk factors for mortality.ResultsA total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio=1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio=4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio=3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio=1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio=6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio=4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio=19.18; 95% confidence interval: 6.47, 56.83).ConclusionsThis national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

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Section: Discussionmentioning

confidence: 99%

Age and Multimorbidities as Poor Prognostic Factors for COVID-19 in Hemodialysis: a Lebanese National Study

Aoun

Khalil

Mahfoud³

et al. 2020

Preprint

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“…Early reports from Italy pointed to KRT patients being at high risk of infection and mortality [16]. In April, Spain reported registry data for 868 patients in KRT with CO-VID-19 [17], of which 63% were in HD, 4% in PD, and 36% had a kidney transplant. A total of 85% were hospitalized, of which 8% were admitted to the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…A study from France reported 38 SARS-CoV-2-infected patients out of 200 maintenance HD pa-tients, with a mortality of 21%. All infected patients had lymphopenia and an increase in CRP levels; however, any predictive factors regarding outcome were not presented [17]. The ERA-EDTA is currently collecting data in the newly established ERA-EDTA COVID-19 Database of Kidney Replacement Therapy patients (ERACODA) registry.…”

Section: Discussionmentioning

confidence: 99%

“…AKI in severe COVID-19 has led to a surge in the need for RRT and increased mortality. The widespread clinical challenge of mobilizing not only mechanical ventilators but also all possible dialysis resources, which may compete with resources for chronic dialysis patients, has been a formidable undertaking during the first waves of this epidemic [3-6, 16, 17, 20-23]. As new waves of COVID-19 emerge, mitigation policies to minimize the risk of exposing high-risk populations to the virus remain important.…”

Section: Discussionmentioning

confidence: 99%

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The COVID-19 Epidemic: Management and Outcomes of Hemodialysis and Peritoneal Dialysis Patients in Stockholm, Sweden

Smolander

Bruchfeld

2021

Kidney Blood Press Res

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Background: The COVID-19 outbreak has been associated with a high morbidity, mortality, and a risk of long-term sequelae, and patients with severe COVID-19 are at increased risk of acute kidney injury. CKD patients are at high risk of being exposed to COVID-19 and suffer complications and poor outcome. In Sweden, mitigation strategies did not include lockdown. During March–April of 2020, wide-spread infection occurred in Stockholm. Methods: Management and outcomes in forty hemodialysis (HD) patients and 4 peritoneal dialysis (PD) patients, with symptomatic COVID-19 in greater Stockholm during March and April of 2020 are reported. Results: Twenty-four HD patients (60%) required medical care and hospitalization, whereas 16 patients (40%) were treated at home. Nine patients died (mortality rate of 22.5%), of whom 8 were men. The median age in non-survivors (78 years) was significantly higher than in survivors (p = 0.003). The median time in dialysis (11.5 years) was also significantly longer in non-survivors (p = 0.01). C-reactive protein (CRP) at diagnosis in 7 of non-survivors (median 213 mg/L, range 86–329 mg/L) was significantly higher than the CRP in 25 survivors (median 87 mg/L, range 1–328 mg/L) (p = 0.0003). Maximum CRP also indicated poorer outcome among hospitalized patients (p = 0.0004). The gender imbalance was striking with only men dying apart from 1 elderly woman. Only 4 PD patients were hospitalized with symptomatic COVID-19. One patient died, 2 were discharged, and 1 was treated at the intensive care unit and survived. Conclusion: HD patients >70 years were reported with longer dialysis vintage, higher CRP, and males were at an increased risk of dying from COVID-19, whereas those <70 years seemed to have a milder disease. Mitigation strategies to reduce rates of infection in high-risk populations remain essential. Follow-up focusing on long-term prognosis for extrapulmonary manifestations is likely to be important also in dialysis patients.

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“…Recent studies have described the incidence, clinical and radiologic features, laboratory characteristics, and hyperinflammatory parameters, therapeutic strategies, recovery, evolution, outcome, and screening of COVID-19 in MHD patients [10,11,[14][15][16][17][18]23]. However, there are few studies on the technique and the dialyzer used in patients with COVID-19 undergoing hemodialysis [10,19,20], as well as on the response of this infection on the removal of the inflammatory parameters.…”

Section: Discussionmentioning

confidence: 99%

Targeting Cytokine Storm in COVID-19: A Role of Online Hemodiafiltration with Asymmetric Cellulose Triacetate in Maintenance Hemodialysis Patients—A Report of 10 Cases

Merino

Valga

Marschall

et al. 2021

Case Reports in Nephrology

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Early reports have suggested that maintenance hemodialysis (MHD) patients could be more susceptible to a severe course of COVID-19. Among the therapeutic approaches, the use of drugs that reduce the cytokine storm characteristic of this disease has been proposed. Some dialyzers, such as the new generation of asymmetric cellulose triacetate (ATA) membranes, could favor the effective elimination of medium-sized molecules and other inflammatory mediators. In this case series, we describe in depth the clinical, analytical, and radiological details, therapeutic aspects, and outcomes of the case series of 10 MHD patients of our dialysis unit, who tested positive for SARS-CoV-2 from 5 October to 30 November 2020. Furthermore, we evaluate the removal of hyperinflammatory parameters with the ATA membrane in postdilution online hemodiafiltration (OL-HDF) in these patients through a variety of biomarkers of systemic inflammation from the diagnosis until stripping. Biochemical blood analysis was carried out at baseline and at days 7 and 14 after diagnosis, respectively. 50% of the patients presented COVID-19 pneumonia and required hospital admission. Median hospitalization time was 21 days. A total of 4 patients developed severe pneumonia (3 of them died) and 1 patient developed moderate pneumonia. Patients who died (n = 3) were more likely to present bilateral pneumonia (100% vs 14.3%) at diagnosis and less reduction in interleukin 6 (IL-6) at day 14, as compared to those who survived. The use of the ATA membrane could be considered a therapeutic option, due to its immunomodulatory effect in MHD patients with SARS-CoV-2 infection, especially at the beginning of the disease, where the inflammatory component is predominant.

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COVID-19 in Patients Undergoing Hemodialysis: Prevalence and Asymptomatic Screening During a Period of High Community Prevalence in a Large Paris Center

Cited by 35 publications

References 21 publications

Age and Multimorbidities as Poor Prognostic Factors for COVID-19 in Hemodialysis: a Lebanese National Study

Age and Multimorbidities as Poor Prognostic Factors for COVID-19 in Hemodialysis: a Lebanese National Study

The COVID-19 Epidemic: Management and Outcomes of Hemodialysis and Peritoneal Dialysis Patients in Stockholm, Sweden

Targeting Cytokine Storm in COVID-19: A Role of Online Hemodiafiltration with Asymmetric Cellulose Triacetate in Maintenance Hemodialysis Patients—A Report of 10 Cases

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