A clinical study on the changing dynamics of disease severity, management strategies and outcomes of COVID-19 in patients requiring haemodialysis

Abstract

Introduction In this observational study, we describe the change in the clinical profile and outcome of Corona Virus Disease 2019 (COVID-19) over the course of the outbreak, among patients requiring dialysis, including chronic haemodialysis therapy. Methods This is a single-centre prospective observational study of patients with COVID-19 (as confirmed by RT-PCR) and renal failure requiring haemodialysis. Their clinical profiles and outcomes were analysed, vis-à-vis the changing disease severity. Findings A total of 483 patients were included, of whom 416 had end-stage renal disease and were on maintenance haemodialysis. Patients who were symptomatic at presentation had significantly higher levels of Neutrophil–lymphocyte ratio (NLR) ( p < 0.001), C-reactive protein (CRP) ( p < 0.001), lactate dehydrogenase (LDH) ( p < 0.001), higher degrees of lung involvement ( p < 0.001) and required more respiratory support ( p < 0.001). The overall mortality observed was 18.8%. In the late phases of the outbreak, there was a significant increase in disease severity without a statistically significant increase in mortality. Predictors of mortality on univariate analysis were age, diabetes mellitus, acute on chronic kidney disease, presence of symptoms on admission, NLR, CRP, LDH, computed tomography (CT) chest grades 3 and 4, and need for respiratory support; however, only age and the renal syndrome of acute on chronic kidney disease retained significance on multivariate analysis ( p 0.003 and p 0.019, respectively). Conclusion Among patients on haemodialysis, higher mortality was observed in patients who were older, and among those with acute on chronic kidney disease. In the late phase of the outbreak, there was a statistically significant increase in disease severity without a corresponding increase in mortality. Graphic abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01072-4.

Comparing Humoral and Cellular Adaptive Immunity during Convalescent Phase of COVID-19 in Hemodialysis Patients and Kidney Transplant Recipients

“…Generally, hemodialysis patients are characterized by uremia-related immunological abnormalities, such as decreased general blood counts and malfunction of immune cells [ 40 ]. Blood morphology-derived parameters obtained from five-part differential blood count were shown to be altered in various inflammatory states, including COVID-19 [ 41 ], which was also observed for CKD COVID-19 patients [ 42 , 43 , 44 ]. Renal dysfunction is associated with an increase in endothelial injury-related BNP and NT-pro-BNP markers that were found to be associated with disease severity and mortality in COVID-19 patients [ 45 ].…”

Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK

“…Especially early in the pandemic, admission was also prompted for logistical reasons, such being unable to dialyse a symptomatic patient with confirmed or suspected COVID-19. 26 …”

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: associations with mortality in a haemodialysis cohort

“…Interest in lymphocyte ratios has also grown in the context of the COVID-19 pandemic and meta-analyses have demonstrated positive associations between NLR at COVID-19 presentation and COVID-19 disease severity and mortality in general adult COVID-19 populations [11][12][13]. Similar findings have been reported in smaller studies in dedicated CKD populations with COVID-19 disease [14][15][16][17].…”