Clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 and impact of proactive chest computed tomography scans

Abstract

Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that first manifested in humans in Wuhan, Hubei Province, China, in December 2019, and has subsequently spread worldwide. Methods We conducted a retrospective, single-center case series of the seven maintenance hemodialysis (HD) patients infected with COVID-19 at Zhongnan Hospital of Wuhan University from 13 January to 7 April 2020 and a proactive search of potential cases by chest computed tomography (CT) scans. Results Of 202 HD patients, 7 (3.5%) were diagnosed with COVID-19. Five were diagnosed by reverse transcription polymerase chain reaction (RT-PCR) because of compatible symptoms, while two were diagnosed by RT-PCR as a result of screening 197 HD patients without respiratory symptoms by chest CT. Thirteen of 197 patients had positive chest CT features and, of these, 2 (15%) were confirmed to have COVID-19. In COVID-19 patients, the most common features at admission were fatigue, fever and diarrhea [5/7 (71%) had all these]. Common laboratory features included lymphocytopenia [6/7 (86%)], elevated lactate dehydrogenase [3/4 (75%)], D-dimer [5/6 (83%)], high-sensitivity C-reactive protein [4/4 (100%)] and procalcitonin [5/5 (100%)]. Chest CT showed bilateral patchy shadows or ground-glass opacity in the lungs of all patients. Four of seven (57%) received oxygen therapy, one (14%) received noninvasive and invasive mechanical ventilation, five (71%) received antiviral and antibacterial drugs, three (43%) recieved glucocorticoid therapy and one (14%) received continuous renal replacement therapy. As the last follow-up, four of the seven patients (57%) had been discharged and three patients were dead. Conclusions Chest CT may identify COVID-19 patients without clear symptoms, but the specificity is low. The mortality of COVID-19 patients on HD was high.

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients

“…This hyper-inflammatory storm may play a role in the tissue damage and death of patients [4,48]; however, this response is blunted in infected HD patients. Several studies have revealed leukopenia, lymphopenia, lower serum calcium concentration, and elevated CRP levels in HD patients; however, other researchers have failed to find changes in numbers of granulocytes or lymphocytes in infected HD patients [17][18][19]21,22]. Ma Y et al found that the counts of T cells, CD4 T cells, CD8 T cells, natural killer cells, and B lymphocytes were reduced in the peripheral blood of infected HD patients compared with non-HD patients.…”

Kidney disease and electrolytes in COVID-19: more than meets the eye

“…In fact, COVID-19-related kidney injury may also aggravate heart failure. (3) Both the development of kidney injury in the course of COVID-19 as well as pre-existent CKD not on dialysis or on RRT by kidney transplantation (Tx), HD or PD are associated with an increased risk of death [ 11 , 43 , 44 ]. Thus prevention strategies should be emphasized in HD patients and also in PD patients and kidney transplant programmes should be stopped at the peak of the pandemic [ 39–42 , 49 ].…”

“…Wang et al . (Wuhan, China) [ 44 ] report on 7 of 202 HD patients diagnosed with COVID-19 at a mean age of 59 years, thus a different patient population from the Italian series. Computed tomography scan was used as a screening method for the whole HD population and bilateral ground-glass lung opacities and consolidation were the most common radiologic findings.…”

Evaluation of COVID-19 Thorax Computed Tomography Findings in Hemodialysis Patients

“…Considering the pathogenesis of lung involvement findings in COVID-19 infection and changes in the immune system response in HD patients, it is not known whether the frequency of lung involvement findings will differ in this group of patients. In the study by Wang et al (14), bilateral diffuse consolidation or groundglass appearances were observed in all 7 HD patients who were diagnosed with COVID-19, and death was reported in 3 of the patients. In the study of Du et al (11) with 32 COVID-19 positive HD patients, ground-glass opacities were observed in 18 cases; unilateral consolidations were observed in 7 patients, bilateral consolidations were observed in 7 patients; and pleural effusion was observed in 2 patients.…”