Background: The passive immunization of patients with SARS-CoV2 with convalescent plasma (CP) is theoretically beneficial in patients with end-stage renal disease who are immunosuppressed and unable to mount an adequate immune response. Hence, this study was conducted to evaluate the safety and efficacy of CP in patients with chronic kidney disease on hemodialysis with moderate-to-severe SARS-CoV2 infection.Methods: A prospective observational cohort study was conducted in consecutive 68 moderate-to-severe SARS-CoV2 infected patients who were on maintenance hemodialysis or with acute worsening of chronic kidney disease which required initiation of hemodialysis. Patients who received CP were compared with those who did not. The primary outcome was death during hospitalization. Clinical characteristics, duration of hospitalization and inflammatory parameters were compared between the two groups. A subgroup analysis was done to find whether early initiation of plasma was associated with better outcome. Results: Sixteen patients (44%) in the plasma group and 14 (45%) patients in the control group died during hospitalization (p = 0.95). The median duration of hospitalization was 9 (6-14) days in the plasma group and 9 (6-16) in the control group (p = 0.60). There was no difference in mortality or duration of hospitalization with respect to early initiation of CP (p = 0.29). Fistula thrombosis occurred in two patients (11.1%) in the plasma group. Conclusion:Therapy with CP does not appear to confer any clinical benefit in moderate-to-severe SARS-CoV-2 infected patients with chronic kidney disease on hemodialysis.

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Metabolic acidosis is known to have adverse consequences in patients with chronic kidney disease (CKD) including protein-energy wasting, inflammation, bone disease, and disturbance in endocrine function. Unlike in the management of patients with predialysis CKD, bicarbonate levels were not being routinely monitored in dialysis patients at our center. The KDOQI guidelines recommend serum bicarbonate levels ≥22 mEq/L in patients on dialysis. We measured the predialysis serum bicarbonate levels in 100 adult patients on regular hemodialysis (HD) and 41 adult patients on peritoneal dialysis (PD). We also studied the extent of rise in serum bicarbonate levels from predialysis levels after HD in our patients. Predialysis serum bicarbonate level was <22 mEq/L in 73% of patients on HD and 12% of patients on PD. The serum bicarbonate levels remained <22 mEq/L at the end of HD in 41% of patients on HD. Thirty-nine percent of patients were on a HD schedule of thrice a week, and 93% of PD patients performed three PD exchanges a day. The dialysate bicarbonate level was 34 mEq/L. There was a significant increase in serum bicarbonate levels with HD, but the mean postdialysis bicarbonate level was 23.45 mEq/L. A very high proportion of our patients on HD continued to have uncorrected metabolic acidosis, with metabolic acidosis persisting in the immediate postdialysis period in a significant number of patients. Predialysis serum bicarbonate level needs to be monitored in patients on HD. There is an urgent need to modify HD prescription to ensure better correction of metabolic acidosis in our HD population. Compared to HD, the proportion of patients having persistent metabolic acidosis is significantly lower in PD.