The Spectrum of Clinical and Serological Features of COVID-19 in Urban Hemodialysis Patients

Abstract

Introduction: The inherent immunosuppression of uremia increases the susceptibility of hemodialysis patients to infection. There is still limited evidence on hemodialysis patients and COVID-19. The clinical and analytical spectrum and treatment responses and mortality are poorly characterized. Material and Methods: Clinical and analytical features, chest X-ray, polymerase chain reaction (PCR) and antibodies for SARS-CoV-2, treatment and outcomes were analyzed in 48 patients diagnosed with COVID-19 during March and April 2020 in two coordinated Spanish hemodialysis units. Results: In 200 haemodialysis patients, COVID-19 was diagnosed in 48, of whom 22 were PCR positive, eight PCR negative but seroconverted and two were diagnosed on typical clinical grounds. Despite a mean age of 72.6 years, the overall mortality rate was 5/48 (10%). Among the PCR positive patients, 21 (55%) required admission and five (13%) died. PCR positive patients were more often symptomatic and hospitalized and had higher troponin I levels than PCR negative patients, but did not differ in lymphocyte counts, D-dimer or interleukin-6 (IL-6) levels. Among PCR negative COVID-19 patients, three out of 10 (30%) required admission, and none died. The most frequent symptom among the 48 patients was fever (31%), followed by asymptomatic patients (23%). A low number of lymphocytes was the only parameter significantly different between hospitalized and ambulatory COVID-19 patients, independently of PCR status. Conclusions: COVID-19 hemodialysis patients are frequently asymptomatic, and mortality may be lower than previously reported. Diagnosis may be retrospective, based on seroconversion, as PCR may be negative. This information should guide preventive and patient isolation strategies.

Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort

“…Our global incidences are lower compared with the first published haemodialysed patient cohorts from Brescia, Italy (15%) [ 8 ] and Madrid, Spain (13%) [ 10 ], but higher compared with the cohort from Wuhan, China (2.5%) [ 9 ]. More recently, new cohorts from Italy [ 14 ] and Spain [ 15 ] report similar results, with higher incidences (26 and 24%, respectively) compared with the second published cohort from Wuhan, China (3.5%, despite a large screening of asymptomatic by chest CT) [ 16 ]. Canadian [ 17 ] and Turkish [ 18 ] cohorts reported incidences of 4.6 and 1.1%, respectively.…”

“…The mortality rate in our study, while very much higher than that observed in the general population [ 4 ], is comparable to cohorts from Wuhan (31%) [ 9 ], Brescia (28%) [ 8 ] and Madrid (30%) [ 10 ]. The recently published cohorts reported a mortality of 43% in China [ 16 ], 25% in Italy [ 14 ] and 10% in Spain [ 15 ], and no deaths have been reported from Canada [ 17 ] and Turkish [ 18 ] cohorts. The small numbers of COVID-19 cases in these studies may explain this heterogeneity concerning mortality.…”

Antibody Response Following SARS-CoV-2 Infection and Implications for Immunity: A Rapid Living Review

“…(2) 45 cross-sectional or cohort studies [18][19][20][21][22][23]25,26,29,31,32,35,37,[39][40][41][42][43][44]47,48,[51][52][53][54][55][56][58][59][60][61][62][63][64][67][68][69]71,[74][75][76][77][78][79][80] characterizing the antibody response (i.e., antibody types, levels, and duration) among adults with SARS-CoV-2 infection; and 317 studies validating the diagnostic performance of one or more immunoassays. 16,17,24,27,…”

“…Staines, 2020 59 Hypertension and body mass index were associated with seroconversion. Stock da Cunha, 2020 60 Among patients with end-stage renal disease on hemodialysis, 13% of patients had not developed antibodies at a mean of 13 days after having a positive PCR. Wang B, 2020 68 Among patients with multiple myeloma, 96% (22/23) Chen, Y.…”

Chronic kidney disease: the most prevalent risk factor and the risk factor that increases most the risk for lethal COVID-19

“…Estudios recientes están caracterizando la naturaleza de COVID-19 en los pacientes con ERC, diálisis o trasplante, identificando factores de riesgo para enfermedad grave y mortalidad, así como el patrón de temporal de la alteraciones clínicas y analíticas (21)(22)(23)(24)(25)(26). No obstante, no hay información sobre la respuesta ante la vacunación, que puede ser deficiente (27).…”