Hydroxychloroquine and azithromycin tolerance in haemodialysis patients during COVID-19 infection

Abstract

Background Haemodialysis patients are at risk of developing severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: coronavirus disease 2019 (COVID-19). In March 2020, hydroxychloroquine (HCQ) and azithromycin (AZI) were proposed as potential treatments of COVID-19, but with warnings concerning their possible toxicity. No data are available regarding the toxicity of this treatment in haemodialysis patients. Methods We report the use of HCQ and AZI in a cohort of COVID-19 haemodialysis patients with focus on safety concerns. Results Twenty-one patients received 200 mg HCQ thrice daily during 10 days, and AZI 500 mg on Day 1, and 250 mg on the four following days. HCQ plasma concentrations were within the recommended range (0.1–1.0 µg/mL) in all patients except one, in which maximum concentration was 1.1 µg/mL. HCQ concentration raised until the third day and remained stable thereafter. No cardiac event occurred in spite of progressive lengthening of corrected QT interval (QTc) during the treatment. One patient experienced a long QTc syndrome (QTc >500 ms) without any arrhythmia episode, although HCQ concentration was in the target range. Five (23.8%) patients experienced hypoglycaemia, a well-known HCQ side-effect. SARS-CoV-2 RNA remained detectable in nasopharyngeal swabs for a long time in haemodialysis patients (mean time 21 days). Conclusions HCQ and AZI are safe in haemodialysis patients at these doses but can lead to long QTc syndrome and hypoglycaemia. HCQ concentrations were not correlated with side effects. We recommend monitoring of the QTc length throughout treatment, as well as glycaemia. SARS-CoV-2 could persist for longer in haemodialysis patients than in the general population.

Age and Multimorbidities as Poor Prognostic Factors for COVID-19 in Hemodialysis: a Lebanese National Study

“…Hydroxychloroquine was also found safe in a French series of 21 hemodialysis patients [34]. In our extremely ill patients admitted to the ICU, antiviral treatment did not show any bene t regarding mortality but we cannot make further conclusions because it was prescribed in severe cases, which is considered as a bias of indication.…”

Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

“…Finally, the treatment used in the first diagnosed patients was hydroxychloroquine and did not cause an increase in death as opposed to the study published by the Spanish kidney registry in March 2020 [ 22 ]. Hydroxychloroquine was also found safe in a French series of 21 hemodialysis patients [ 34 ]. In our extremely ill patients admitted to the ICU, antiviral treatment did not show any benefit regarding mortality but we cannot make further conclusions because it was prescribed in severe cases, which is considered as a bias of indication.…”

Evaluation of Dialysis Adequacy, Interdialytic Weight Gain and Quality of Life of Hemodialysis Patients within Coronavirus Disease 2019 Pandemic

“…Most of the respondents in this study were middle-aged and had undergone hemodialysis for more than 6 months. Several studies have also found the same patient profiles [9], [14], [15], [16] Patients who have been on hemodialysis for a long time tend to be more disciplined in observing therapy schedule despite facing obstacles because they feel the benefits of undergoing therapy [17].…”

“…The previous studies on the effects of COVID-19 in hemodialysis patients have focused more on the characteristics of hemodialysis patients suffering from COVID-19 [3], [6], [7], [8], impact of drug trials on hemodialysis patients suffering from COVID-19 [9], and case report of hemodialysis patients with COVID-19 [10], [11]. No study examined hemodialysis adequacy, IDWG, and the quality of life of hemodialysis patients during the pandemic.…”