Epidemiological, Clinical, and Immunological Features of a Cluster of COVID-19–Contracted Hemodialysis Patients

Abstract

Background: The outbreak of highly contagious coronavirus disease 2019 (COVID-19) has posed a serious threat to human life and health, especially for those with underlying diseases. However, the impact of COVID-19 epidemic on hemodialysis (HD) centers and HD patients has not been reported. Methods: We reviewed the whole course of the COVID-19 in the HD center of Renmin Hospital, Wuhan University (from January 14, 2020, to March 12, 2020). We compared the clinical manifestation and immune profiles among different patient groups with healthy individuals. Results: Forty-two of 230 HD patients (18.26%) and 4 of 33 medical staff (12.12%) were diagnosed with COVID-19 during the study period. Fifteen HD patients (6.52%), including 10 COVID-19 diagnosed, died. Only 2 deaths of the COVID-19 HD patients were associated with pneumonia/lung failure, others were ascribed to cardiovascular/cerebrovascular diseases or hyperkalemia. Except for 3 patients who were admitted to the intensive care unit for a severe condition (8.11%), including 2 who died, most COVID-19 diagnosed patients presented mild or nonrespiratory symptoms. The flow cytometric analysis of peripheral blood showed that multiple lymphocyte populations in HD patients were significantly decreased. HD patients with COVID-19 even displayed more remarkable reduction of serum inflammatory cytokines than other patients with COVID-19. Conclusions: Compared with the general population, HD patients and health care professionals are the highly susceptible population and HD centers are high-risk areas during the outbreak. Most HD patients with COVID-19 exhibited mild clinical symptoms and did not progress to severe pneumonia, likely due to the impaired cellular immune function and incapability of mounting cytokine storm. More attention should be paid to prevent cardiovascular events, which may be the collateral impacts of the COVID-19 epidemic on HD patients.

Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States

“…42,43 In addition, a lower percentage of patients with pre-existing kidney disease (regardless of whether treated by dialysis) reported respiratory symptoms (shortness of breath and cough) and fever compared with patients without kidney disease. These findings are consistent with existing reports 23,37 and highlight the necessity of vigilance for nontraditional COVID-19 symptoms such as altered mental status and gastrointestinal symptoms.…”

“…[11][12][13] We also found that dialysis patients receiving ICU-level care for COVID-19 had an in-hospital death rate of 50%, which is lower than rates reported in regional studies. [36][37][38] Strikingly, the unadjusted death rate among nondialysis patients with CKD (51%) was equivalent to that of dialysis patients (50%) yet notably higher than that of patients without underlying kidney disease (35%). These findings not only highlight the importance of discussing COVID-19 risks with patients with CKD, regardless of whether they are receiving maintenance dialysis, but also engaging in advance care planning conversations in the ambulatory setting, before patients falling ill with COVID-19.…”

End-Stage Renal Disease Patients on Chronic Hemodialysis Fare Better With COVID-19: A Retrospective Cohort Study From the New York Metropolitan Region

“…An immune-deficient state was indeed demonstrated by Ma et al in their study [8]. A significantly lower number of T cells, natural killer cells, and B cells in ESRD-HD patients was seen compared with patients not on dialysis [8].…”

“…This was also observed firsthand by the authors by being on the frontlines in New Rochelle, New York, one of the first COVID-19 epicenters in the United States. Only one other group of researchers has described a lower severity of disease in dialysis patients with COVID-19 [8]. In that study, Ma et al describe mostly mild clinical symptoms in patients with ESRD and a low likelihood of progression to severe pneumonia in ESRD-HD patients in an outpatient setting.…”

COVID-19 and ESRD: Entering a New Era of Uncertainty

“…In Wuhan, China, 12% of the dialysis center staff at Renmin Hospital contracted COVID-19, whereas in Lombardy, Italy, a 33% infection rate was reported among the hospital dialysis staff. 2,3 To that end, we have 4 reports published in Kidney International Reports from Wuhan, China; the Lombardy region of northern Italy; London, England; and Paris, France 2-5 detailing their early experience with COVID-19 outbreaks affecting patients with end-stage renal disease at outpatient dialysis facilities and leading to a large number resulting in hospitalization and, often, death, similar to our experience in New York City. 6 Based on the aggressiveness of testing, these reports show an infection rate of 11% to 26% among patients with end-stage renal disease.…”