Presentation and Outcomes of Patients with ESKD and COVID-19

Abstract

BackgroundThe relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.MethodsTo examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.ResultsTwo of the study’s 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7×103/μl), as was C-reactive protein (163 versus 80 mg/L).ConclusionsThe association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population.

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

“…[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.…”

Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis

“…Besides, the use of nonsteroidal anti-inflammatory drugs (NSAID) and corticosteroid is quite prevalent in people with long-term, chronic illnesses, but it is important to remember that these drugs must be used with caution considering its side effects [ 44 , 45 ]. However, it is found that the use of NSAID and RAS inhibitors had no significant effect on AKI in the first 48 h or increased death, while relative immunosuppression due to steroid consumption and high prevalence of comorbidities raise concerns about the development of poor outcomes [ 32 , 46 ].…”

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

“…The overall mortality in our population was 9.2%. Some series have mortality rates of 14-31% in China (14), United Kingdom 19% (15), Turkey 20% (16), Spain 23% (5), Italy 28% (17), and the United States 31% (18). A recent published study from French dialysis units (COVIDIAL) reported mortality of 24%.…”