Long‐term effects of COVID‐19 in a patient on maintenance dialysis

Abstract

Coronavirus infectious disease (COVID-19) is a novel respiratory infection highly associated with severe complications in elderly subjects affected by cardiovascular disease. Patients on maintenance dialysis are exceptionally vulnerable because most of them are old and have multiple comorbidities. We report the complex clinical course of SARS-CoV-2 infection in a patient on maintenance dialysis who presented with fever and lung edema. After 41 days from the primary infection, the clinically recovered patient experienced symptomatic reactivation of SARS-COV-2 infection documented by positive polymerase chain reaction (PCR) result on nasal/oropharyngeal swab along with immunoglobulin M seroconversion. The recurrence of PCR positivity forced us to perform hemodialysis in a separate isolation room for a prolonged period of time. Close monitoring of previously infected patients and restructuring of dialysis facilities are necessary to avoid new outbreaks of this concerning disease.

The frail world of haemodialysis patients in the COVID-19 pandemic era: a systematic scoping review

“…On average shedding of viral particles lasted 15.1–29 days in infected patients on HD [ 135 , 139 ]. Two studies reported that HD patients tested positive for SARS-CoV-2 RNA on repeated testing despite being negative on two prior consecutive nasopharyngeal swabs [ 138 , 140 ]. Prolonged viral RNA shedding has been reported until 79 days in an adult HD patient [ 140 ] and 28 days in a pediatric patient [ 141 ].…”

“…Two studies reported that HD patients tested positive for SARS-CoV-2 RNA on repeated testing despite being negative on two prior consecutive nasopharyngeal swabs [ 138 , 140 ]. Prolonged viral RNA shedding has been reported until 79 days in an adult HD patient [ 140 ] and 28 days in a pediatric patient [ 141 ]. Only one anecdotal case of reinfection has been reported in a dialysis patient [ 142 ].…”

One‐year persistence of neutralizing anti‐SARS‐CoV‐2 antibodies in dialysis patients recovered from COVID‐19

“…On average, SARS‐CoV‐2 RNA shedding was measured for 44.6 ± 26.1 days; in one patient viral genetic material was detected for 74 days from the diagnosis of COVID‐19 and 79 from symptoms onset. 6 After the clearance of the virus, no cases of COVID‐19 reinfection were documented in these patients. As detailed in Table 1 , anti‐spike IgG antibodies (Ab) were measured in the serum of these three survivors after 1 year (range, 366–374 days) from the diagnosis of the SARS‐CoV‐2 infection.…”

“…After discharge, this group of patients continued to receive appropriate dialysis therapy in a separated room until the detection of two negative nasopharyngeal swabs for SARS‐CoV‐2. On average, SARS‐CoV‐2 RNA shedding was measured for 44.6 ± 26.1 days; in one patient viral genetic material was detected for 74 days from the diagnosis of COVID‐19 and 79 from symptoms onset 6 . After the clearance of the virus, no cases of COVID‐19 reinfection were documented in these patients.…”

COVID-19 and Dialysis Patients: Unsolved Problems in Early 2021

“…“Long-hauler” clinics caring for and studying these patients will hopefully shed light on their pathophysiology. 7 …”