Clinical presentation and outcome of severe acute respiratory syndrome in dialysis patients

Abstract

There was a major outbreak of severe acute respiratory syndrome (SARS) affecting more than 300 patients occurring in a private housing estate in Hong Kong, in which an infected renal patient was suspected to be the primary source. It is unknown whether renal patients would represent a distinct group of patients who share some characteristics that could predispose them to have higher infectivity. In this context, we have encountered 4 dialysis patients contracting SARS in a minor outbreak, which involved 11 patients and 4 health care workers, in a medical ward of a regional hospital. Of these 4 dialysis patients, 1 patient was receiving hemodialysis while the other 3 patients were on continuous ambulatory peritoneal dialysis. Fever and radiological changes were their dominant presenting features. All were having positive results for SARS-associated coronavirus ribonucleic acid by reverse transcriptase-polymerase chain reaction performed on their nasopharyngeal aspirates or stool samples. It appeared that treatment with high-dose intravenous ribavirin and corticosteroids could only resolve the fever, but it could not stop the disease progression. All 4 patients developed respiratory failure requiring mechanical ventilation on days 9 through 12. At the end, all of the patients died from sudden cardiac arrest, which was associated with acute myocardial infarction in 2 cases. From this small case series, it appeared that dialysis patients might have an aggressive clinical course and poor outcome after contracting SARS. However, a large-scale study is required to further examine this issue, and further investigation into the immunologic abnormalities associated with the uremic state in this group of patients is also warranted.

Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China

“…It has been speculated that a patient having renal failure might carry an extraordinarily high viral load of SARS, which could lead to a large outbreak. 14 Kwan et al 15 reported that dialysis patients have a higher rate of contracting SARS (1.72%) compared with the general population (0.003% in Hong Kong), but the degree of disease severity, and the mortality rate of the dialysis group was similar to the control group. Given the fact that SARS-CoV-2 has up to 85% sequence similarity with SARS, 16 we should be alert to the possibility that the epidemiologic and clinical characteristics of COVID-19 could follow the same trend as SARS in patients undergoing MHD.…”

Acute renal impairment in coronavirus-associated severe acute respiratory syndrome

“…A wide range of nonrespiratory symptoms has subsequently been reported suggesting other organ involvements including the liver and gastrointestinal tract during the course of the disease [4,10,11]. With the exception of a few chronic dialysis patients complicated by SARS [12][13][14], impaired renal function with raised plasma creatinine is not a common finding in most SARS patients at the time of first clinical presentation. A preliminary study of 12 patients with SARS who developed ARF reports a high mortality rate of 77% [abstract; Tsai HB, et al, J Am Soc Nephrol 14:513A, 2003).…”

Severe Acute Respiratory Syndrome in Dialysis Patients

“…At presentation, patients on dialysis exhibit similar symptoms (fever, myalgia, chills and rigors, gastrointestinal symptoms) as the nondialysis patients (1). However, it is our impression that dialysis patients tend to have less pronounced symptoms (8,9), which may be difficult to distinguish from uremic symptoms. In addition, dialysis patients tended to seek medical attention at a later stage, which might cause a delay in diagnosis and treatment.…”