High prevalence of asymptomatic COVID-19 in hemodialysis. Daily learning during first month of COVID-19 pandemic

Albalate, Marta; Arribas, Patricia; Torres, Esther; Cintra, Melissa; Alcázar, Roberto; Puerta, Marta; Ortega, Mayra; Procaccini, Fabio; Martín, Juan David; Jiménez, Eva; Fernández, Isabel Sainz; Sequera, Patricia de; Perez-Villar, M. I.; Romero, Rodolfo; Rodriguez-Suarez, E.; Ramos, Alex Sandro Lins; Liébana, B.; Vinagre, Gustavo; Oros-Ruíz, Socorro; Herrera, Eileen; Quesada, Marina; Saenz, A; Argote, Pablo; García-Martínez, Pedro; Bermejo, Marta Bermejo; Sánchez-Fernández, Nivia Ernestina; Martínez-González, Mayra A.; Cerrajero, R.; Bernabé, María Fernanda; Rojas, Viviana Pahola Rueda; Martínez-Dios, Isabel; Conejo, D.; Rodriguez-Presa, P.; Varona, Yasser; Muñoz-Blazquez, R.; Sanz-Martinez, D.; Montoro, J. J.; Avilés, Agustín

doi:10.1016/j.nefroe.2020.06.013

Cited by 38 publications

(54 citation statements)

References 5 publications

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“…Prevalence of confirmed COVID-19 was 3.2% in KT patients and 3.6% in MHD patients. This prevalence in MHD patients was lower than the 10–41% reported by other groups [ 10 , 11 , 13 , 14 ]. This low prevalence is relevant, as Barcelona has been one of the places with the highest prevalence of COVID-19 in Spain [ 4 ], and Catalonia region ranks second in number of cases included in the Spanish COVID-19 register (18% out of 868 patients), behind Madrid (36%) [ 15 ].…”

Section: Discussioncontrasting

confidence: 65%

“…Recent reports suggest a milder clinical presentation of COVID-19 in renal patients compared with general population [ 10 , 11 , 14 , 24 , 25 ]. However, our COVID-19 confirmed patients presented a high rate of early clinical symptoms, much more intense than those patients whose RT-PCR was negative.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with renal diseases, including the whole spectrum from kidney transplant (KT) to maintenance hemodialysis (MHD) patients, are at high risk for infection and pneumonia, both bacterial and viral [ 7 , 8 ]. The available reports on COVID-19 in these populations underline important incidences and poor outcomes, so early and efficient identification and diagnosis is of utmost importance [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Profiles in Renal Patients with COVID-19

Arenas

Crespo

Pérez‐Sáez

et al. 2020

JCM

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The COVID-19 pandemic has led to frequent referrals to the emergency department on suspicion of this infection in maintenance hemodialysis (MHD) and kidney transplant (KT) patients. We aimed to describe their clinical features comparing confirmed and suspected non-confirmed COVID-19 cases during the Spanish epidemic peak. Confirmed COVID-19 ((+)COVID-19) corresponds to patient with positive RT-PCR SARS-CoV-2 assay. Non-confirmed COVID-19 ((−)COVID-19) corresponds to patients with negative RT-PCR. COVID-19 was suspected in 61 patients (40/803 KT (4.9%), 21/220 MHD (9.5%)). Prevalence of (+)COVID-19 was 3.2% in KT and 3.6% in MHD patients. Thirty-four (26 KT and 8 MHD) were (+)COVID-19 and 27 (14 KT and 13 MHD) (−)COVID-19. In comparison with (−)COVID-19 patients, (+)COVID-19 showed higher frequency of typical viral symptoms (cough, dyspnea, asthenia and myalgias), pneumonia (88.2% vs. 14.3%) and LDH and CRP while lower phosphate levels, need of hospital admission (100% vs. 63%), use of non-invasive mechanical ventilation (36% vs. 11%) and mortality (38% vs. 0%) (p < 0.001). Time from symptoms onset to admission was longer in patients who finally died than in survivors (8.5 vs. 3.8, p = 0.007). In KT and MHD patients, (+)COVID-19 shows more clinical severity than suspected non-confirmed cases. Prompt RT-PCR is mandatory to confirm COVID-19 diagnosis.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Profiles in Renal Patients with COVID-19

Arenas

Crespo

Pérez‐Sáez

et al. 2020

JCM

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“…Among the 43 low quality studies excluded, 28 were studies on proportion of asymptomatic infection [ 17 – 44 ] and 15 were transmission studies [ 45 – 59 ]. Among the studies on proportion of asymptomatic infection excluded, potential selection bias (21/28; 75%) and detection bias (16/28; 57.1%) were the most common concerns, while for the transmission studies excluded, detection bias (15/15; 100%) and reporting bias (14/15; 93.3%) were the most common concerns ( S1 Table ).…”

Section: Resultsmentioning

confidence: 99%

Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

et al. 2020

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Background The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential. Methods We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI). Results Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive. Conclusions Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.

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“…The risk for contracting SARS-CoV-2 infection among dialysis patients is an area that deserves further attention because previous epidemiologic studies of dialysis patients with COVID-19 were limited to outbreaks within centers in China or during the exponential phase of the pandemic in Italy. 8 , 9 , 10 …”

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confidence: 99%

Identifying Disparities in the COVID-19 Pandemic: The Quest for Data

Struthers¹,

Sanghavi²

2020

Kidney Medicine

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T he coronavirus disease 2019 pandemic has resulted in wide-reaching and devastating effects on human health and the global economy. Emerging public health data reveal differential impacts of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection, with socially disadvantaged populations bearing the greatest burden of risk for transmission, morbidity, and mortality. However, in more than half the US cases, relevant race and ethnicity data are missing, exposing major gaps in our federal public health surveillance system. 1,2 Even less is known about the association between socioeconomic status (SES) and COVID-19, information required to contextualize identified racial and ethnic disparities.Inconsistent collection and reporting requirements at the local and state level have subsequently prompted legislation in Congress urging the Centers for Disease Control and Prevention to ensure that disaggregated data are collected and reported on a daily basis. 3 Only recently have more comprehensive albeit still incomplete demographic data become available, showing that ageadjusted infection rates for Blacks and Latino Americans are nearly 3 times those for White Americans, with deaths nearly twice as high. 1 These same groups are also more likely to experience a greater burden of chronic health conditions, including end-stage kidney disease (ESKD). The congregate setting of in-center hemodialysis may further heighten their risk for infection and adverse outcomes during a pandemic. 4,5 The ongoing challenge of obtaining complete, accurate, and timely data pertaining to the COVID-19 pandemic highlights the important contributions made by researchers to the surveillance process. In this issue of Kidney Medicine, Bhayani et al 6 use multiple public health databases to examine the association between SARS-CoV-2 infection and COVID-19 death rates with demographics, poverty status, and in-center hemodialysis in the Chicago metropolitan area. 6 Using electronic records from the Illinois Department of Public Health, the authors collected data for all SARS-CoV-2 positive test results and COVID-19-associated deaths among residents living within the 163 zip codes that comprise Cook County, IL. These data were subsequently merged with zip code-level information from the US Census Bureau, including race, ethnicity, income, and household poverty status as defined by the

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High prevalence of asymptomatic COVID-19 in hemodialysis. Daily learning during first month of COVID-19 pandemic

Cited by 38 publications

References 5 publications

Clinical Profiles in Renal Patients with COVID-19

Clinical Profiles in Renal Patients with COVID-19

Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

Identifying Disparities in the COVID-19 Pandemic: The Quest for Data

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