Impact of first-wave COronaVIrus disease 2019 infection in patients on haemoDIALysis in Alsace: the observational COVIDIAL study

Abstract

Background There are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death. Methods All HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes. Results Among 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66–83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0–5), 7 (4–11) and 32 (26.5–35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25–106) and 690 Ly/µL (IQR 450–960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11–3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005–1.017); P < 0.0001]. Conclusions HD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.

Outcomes of patients with End Stage Kidney Disease on dialysis with COVID-19. From PCR to Antibody.

“…Median age in this population was 77 (IQR 68-83) years and in whose who died was 80 (IQR 72-88) years. 66% of those who died in this study were above the age of 75 years (19). The relatively low mortality within our cohort may re ect a relatively young median age of dialysis patient and older age de nitely appears a risk factor for mortality, as is clear from the associations with mortality (tables 1&2).…”

“…The COVIDIAL study also reported higher mortality in patients who presented with dyspnoea (70% versus 45%; P= 0.027). In patients who died, diabetic nephropathy was more common (48 versus 32%) and had a history of ischemic heart disease (61 versus 41% p=0.084), however, none of the speci c comorbidities were associated with high risk of death (19) There is a reported association between blood group and COVID-19 infection, with group A being more susceptible and group O relatively protected (20)(21)(22). In order to assess whether there was such an association in our data we compared the observed to expected frequency of COVID-19 positive patients was similar to quoted gures for the UAE populations (12-13), we con rmed this association but when corrected for indicative population frequencies, these numbers did not meet statistical signi cance.…”

COVID-19 in ESRD and Acute Kidney Injury

“…The case fatality rate was 24%. Fever and CRP levels were independently associated with adverse outcomes [ 25 ]. In a study from a referral centre from the Paris region including 44 patients, the case fatality rate was 27%.…”

COVID-19 infection in patients receiving hemodialysis in Athens: findings, experience, outcome from a single Dialysis Unit.

“…In Spain and Italy, mortality rates were 30.5% and 23.6% respectively (12, 13). 23.6% was also recorded in the Alsace region of France, where the vast majority of deceased patients died 2 weeks after the onset of the symptoms (14). Furthermore, in Northern Italy the mortality rates of COVID-19 were calculated as 24.6 % for HD patients (15).…”