The COVID-19 Epidemic: Management and Outcomes of Hemodialysis and Peritoneal Dialysis Patients in Stockholm, Sweden

Abstract

<b><i>Background:</i></b> The COVID-19 outbreak has been associated with a high morbidity, mortality, and a risk of long-term sequelae, and patients with severe COVID-19 are at increased risk of acute kidney injury. CKD patients are at high risk of being exposed to COVID-19 and suffer complications and poor outcome. In Sweden, mitigation strategies did not include lockdown. During March–April of 2020, wide-spread infection occurred in Stockholm. <b><i>Methods:</i></b> Management and outcomes in forty hemodialysis (HD) patients and 4 peritoneal dialysis (PD) patients, with symptomatic COVID-19 in greater Stockholm during March and April of 2020 are reported. <b><i>Results:</i></b> Twenty-four HD patients (60%) required medical care and hospitalization, whereas 16 patients (40%) were treated at home. Nine patients died (mortality rate of 22.5%), of whom 8 were men. The median age in non-survivors (78 years) was significantly higher than in survivors (<i>p</i> = 0.003). The median time in dialysis (11.5 years) was also significantly longer in non-survivors (<i>p</i> = 0.01). C-reactive protein (CRP) at diagnosis in 7 of non-survivors (median 213 mg/L, range 86–329 mg/L) was significantly higher than the CRP in 25 survivors (median 87 mg/L, range 1–328 mg/L) (<i>p</i> = 0.0003). Maximum CRP also indicated poorer outcome among hospitalized patients (<i>p</i> = 0.0004). The gender imbalance was striking with only men dying apart from 1 elderly woman. Only 4 PD patients were hospitalized with symptomatic COVID-19. One patient died, 2 were discharged, and 1 was treated at the intensive care unit and survived. <b><i>Conclusion:</i></b> HD patients >70 years were reported with longer dialysis vintage, higher CRP, and males were at an increased risk of dying from COVID-19, whereas those <70 years seemed to have a milder disease. Mitigation strategies to reduce rates of infection in high-risk populations remain essential. Follow-up focusing on long-term prognosis for extrapulmonary manifestations is likely to be important also in dialysis patients.

Humoral response to viral vector COVID-19 vaccine in hemodialysis patients

“…Furthermore, these patients suffer from high morbidity and mortality due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [ 5 , 6 ] and are at high risk of contracting the infection due to continuous visits to medical facilities and exposure to other people, even during peak times of the COVID-19 pandemic [ 7 ]. This study was undertaken to demonstrate the distinct humoral immune response in patients with kidney failure receiving maintenance hemodialysis.…”

Burden of COVID-19 in a Hemodialysis Center in Sub-Saharan Africa

“…The mortality of critically ill patients with SARS-CoV-2 pneumonia is important [4]. Patients on maintenance haemodialysis (MHD) are now recognized to be at high risk and to present with severe forms [5]; this could be explained by the overload in public transport, high concentration in waiting rooms and compromised immune function. But till now, the real impact of COVID-19 pandemic on HD patients has not been largely reported [6].…”

Covid-19 in Egyptian hemodialysis and kidney transplant children: retrospective analysis of single center experience

“…It is now known worldwide that the mortality rate of Covid-19 varies from country to country, age, and specific patient groups [1]. Evidence from adult studies indicates that chronic kidney disease (CKD) and dialysis patients are at high risk of Covid-19 infection [2] and poor outcome [2,3]. Similarly, kidney transplant (KT) recipients were reported to have an increased risk of critical illness, with a mortality rate up to 28% [4] and up to 33% in solid organ transplant (SOT) recipients [5].…”