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

Abstract

Background: End stage kidney disease patients on maintenance dialysis are vulnerable to contract COVID-19 infection and variable degrees of disease severity have been reported. SEHA Kidney Care (SKC) is the largest provider of dialysis services in the United Arab Emirates providing dialysis services to ~1180 patients, including ~80 patients on peritoneal dialysis. Mortality of COVID-19 among patients with ESKD on dialysis is high and ranges from 14 to 31% in different published series. Not much is known about antibody response to COVID-19 in this group of patients. Patient population demographics in the UAE are dissimilar to many other countries. The objective of this study was to describe the characteristics of patients and clinical staff who developed COVID-19 RT-PCR positivity and assess antibody response to COVID-19.Methods: We conducted a retrospective analysis to characterize features of COVID-19 in our adult dialysis population. In addition, IgG antibody serology was also performed to assess response to COVID-19. Results: The incidence of COVID-19 infection in our population was 13%. 81% of the patients were males, average age was 53.2 ± 12​ years, and 95% were on in-center haemodialysis. The majority of patients (68%) developed mild disease while 13% required critical care. Combinations of drugs including Hydroxychloroquine, Favipiravir, Lopinavir, Ritonavir, Camostat, Tocilizumab and steroids were used based on local guidelines. The median time to viral clearance was 15 days [IQR 6-26]. Overall mortality in our cohort was 9.2%.We performed COVID-19 IgG antibody serology in a subset (n=87) of RT-PCR positive patients. Interestingly, 23 (26%) patients did not develop any antibody response. We successfully implemented a regular screening strategy for patients and staff to identify asymptomatic carriers with an aim to isolate them from the rest of the cohort.Conclusions: Our study has highlighted an important finding of lack of antibody response in a quarter of patients with ESKD. This may have significant implications for this group of patients while efforts are underway to develop an effective vaccine against COVID-19. With regular screening of all dialysis patients and staff, asymptomatic carriers can be identified and prevent spread of COVID-19 within the dialysis units.

Outcomes of Patients on Maintenance Hemodialysis Admitted to a Tertiary Care Hospital with COVID-19

“…2 In another study carried out by Ahmed and associates (2020) reported that the mean age of the patients was 52+12 years while the age range was 20 to 85 years. 10 A similar study conducted by Jung and collaborators (2020) confirmed that the mean age of the patients was 63.5+14.5 years and the range was 40-88 years. 16 When the gender of patients was assessed, the study disclosed that the majority (63.6%) of the patients were male while 36.4% were female patients.…”

“…9 The disease clinical presentation is greatly variable, from symptomfree/mild disease (<80 percent), to acute with unilateral/bilateral pneumonia (about 15 percent). 10 The routes of transmission comprise droplet inhalation, person-to-person direct transmission during sneezing, coughing, and with the contact of nasal, oral, as well as mucous membranes of the eye. 11 The disease identification is based upon real-time RT-PCR (reverse transcriptase polymerase-chain-reaction) assay on the nasopharyngeal swabs.…”

The Omicron COVID‐19 threat to dialysis patients is dramatically lower than previous variants

“…in dialysis patients, 1 and on the antibody efficiency of the SinoPharm vaccine in this patient group. 2 Whilst spike antibody levels were sufficiently induced in 50% of patients after a primary course, we saw an increment in antibody levels in most patients.…”

Risks factors for virus shedding period of COVID-19 in maintenance hemodialysis patients: a retrospective cohort study

“…A study by Chen et al[29] that included 267 hospitalized COVID19 patients showed a mean clearance time of 12 days. A study by Wasim et al that included 152 dialysis COVID-19 patients show a median time to viral clearance de ned was 15 days[30].Previous studies have shown that the RNA viral clearance time in general patients with COVID-19 was associated with age, comorbidities (such as obesity, coronary heart disease, hypertension, diabetes), type of COVID-19 and biological parameters (such as leukocyte level, B cells, ACE2 level)[31][32][33][34]. In our MHD patients with COVID-19, we found similar results that more severe lung lesions, more comorbidities, and elder patients, the longer the time to turn negative.…”