COVID-19 in Patients on Maintenance Dialysis in the Paris Region

Abstract

Introduction Coronavirus disease 2019 (COVID-19) represents a serious threat to patients on maintenance dialysis. The clinical setting, mortality rate, and prognostic factors in these patients have not been well established. Methods We included all dialyzed patients with COVID-19 referred to our dialysis center between March 11 and April 11, 2020. Data were obtained through the review of the medical records and were censored at the time of data cutoff, on May 11, 2020. Results Forty-four patients on maintenance dialysis with COVID-19 were referred to our dialysis unit during the COVID-19 epidemic. Median age was 61 years (interquartile range [IQR]: 51.5–72.5); 65.9% were men. Comorbidities included hypertension (97.7%), diabetes mellitus (50%), and chronic cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (79.5%), shortness of breath (29.5%), cough (43.2%), and diarrhea (13.6%). Three profiles of severity were distinguished based on the World Health Organization (WHO) progression scale. Forty-one (93.2%) were hospitalized and only 3 were maintained on outpatient hemodialysis. Thirty-three (75%) patients required oxygen therapy, including 15 (45.5%) who were referred to the intensive care unit. Overall, 27.3% of patients died, and 58.5% were discharged from hospital, including only 2 (13.3%) of those admitted to the intensive care unit. By multivariate analysis, cough, thrombopenia <120 g/l, lactate dehydrogenase (LDH) level greater than 2 times the upper limit of normal, and blood C-reactive protein (CRP) >175 mg/l were significantly associated with death. Conclusion A major outbreak of COVID-19 occurred in the Paris region, and spread among dialyzed patients. Our study underscores the severity of COVID-19 in these patients and identified prognostic markers.

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

“…Previous literature has indicated several risk factors for high mortality in HD, including greater age, male gender, underlying cardiac or pulmonary disease, diabetes and hypertension and the use of mechanical ventilation [15,16,25]. Cough was associated with risk of mortality in French and Italian HD patients [23,34], fever predicted mortality in an Italian HD cohort [28]. Other prognostic factors have included dialysis vintage, thrombocytopenia, lymphopenia, and increased LDH or CRP level [23,28,36].…”

“…Cough was associated with risk of mortality in French and Italian HD patients [23,34], fever predicted mortality in an Italian HD cohort [28]. Other prognostic factors have included dialysis vintage, thrombocytopenia, lymphopenia, and increased LDH or CRP level [23,28,36]. However, most studies have reported less severe clinical symptoms in HD patients compared with the general population [13,19,20,36].…”

COVID-19 and ESRD: Entering a New Era of Uncertainty

“…To that end, we have 4 reports published in Kidney International Reports from Wuhan, China; the Lombardy region of northern Italy; London, England; and Paris, France 2 , 3 , 4 , 5 detailing their early experience with COVID-19 outbreaks affecting patients with end-stage renal disease at outpatient dialysis facilities and leading to a large number resulting in hospitalization and, often, death, similar to our experience in New York City. 6 …”

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

“…Previous literature has indicated several risk factors for high mortality in HD, including greater age, male gender, underlying cardiac or pulmonary disease, diabetes and hypertension and the use of mechanical ventilation [13,14,23]. Cough was associated with risk of mortality in French and Italian HD patients [24,25]. Fever also predicted mortality in an Italian HD cohort [14].…”