SARS-CoV-2 Infection in a Spanish Cohort of CKD-5D Patients: Prevalence, Clinical Presentation, Outcomes, and De-Isolation Results

Abstract

<b><i>Introduction:</i></b> COVID-19 is a highly contagious disease that has easily spread worldwide. Outpatient maintenance hemodialysis seems to entail an increased risk of contagion, and previous reports inform of increased mortality among this population. <b><i>Methods:</i></b> We retrospectively analyzed clinical and laboratory parameters, outcomes, and management once discharged of CKD-5D patients infected with SARS-CoV-2 from our health area. <b><i>Results:</i></b> Out of the 429 CKD-5D population, 36 were diagnosed with SARS-CoV-2 infection (8%): 34 on in-center hemodialysis and 2 on peritoneal dialysis. Five were asymptomatic. The most common symptom was fever (70%), followed by dyspnea and cough. History of cardiovascular disease and elevation of LDH and C-reactive protein during admission were associated with higher mortality. Thirteen patients died (36%), 8 patients were admitted to an ICU, and survival was low (38%) among the latter. The mean time to death was 12 days. Most discharged patients got negative rRT-PCR in nasopharyngeal swabs within 26 days of diagnosis. However, there is a portion of cured patients that continue to have positive results even more than 2 months after the initial presentation. <b><i>Conclusions:</i></b> Patients on dialysis have an increased mortality risk if infected with SARS-CoV-2. Preventive measures have proven useful. Thus, proper ones, such as universal screening of the population and isolation when required, need to be generalized. Better de-isolation criteria are necessary to ensure an appropriate use of public health resources.

Humoral and Cellular Responses to mRNA-1273 and BNT162b2 SARS-CoV-2 Vaccines Administered to Hemodialysis Patients

“…They have more hospital admissions, more extended hospital stays, and greater mortality than the general population 4,5 . In fact, during the disease's first wave in 2020, we found a mortality rate of 34% among hemodialysis patients from our three affiliated units 6 , strikingly higher than the overall 9.7% seen in all admitted patients in our hospital 7 . These poor outcomes have been attributed to the multiple comorbidities afflicting these patients as well as their increased age, fragility, and immunologically deficient state 6,8 .…”

“…In fact, during the disease's first wave in 2020, we found a mortality rate of 34% among hemodialysis patients from our three affiliated units 6 , strikingly higher than the overall 9.7% seen in all admitted patients in our hospital 7 . These poor outcomes have been attributed to the multiple comorbidities afflicting these patients as well as their increased age, fragility, and immunologically deficient state 6,8 . Considering the combination of these high-risk factors, this population must be promptly immunized against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as recommended by several nephrology societies [9][10][11][12] .…”

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

“…All outcome measures were influenced by the sample size, the age of patients, length of follow-up and policy of healthcare delivery. Excluding studies reporting outcome of patient admitted to hospital as a preventive measure and regardless of symptoms, we found that hospitalization of HD patients varied from 35 to 88.2% [ 11 – 13 , 17 , 21 , 32 , 62 , 82 , 93 , 109 , 114 , 116 , 118 , 120 , 127 , 129 , 133 , 136 – 138 , 144 , 145 , 150 , 154 ]. with a percentage of patients requiring ICU admission of 2.6–70.5% [ 6 , 13 , 17 , 21 , 32 , 62 , 109 , 114 , 116 , 118 , 119 , 121 , 125 , 126 , 129 – 134 , 136 , 138 , 143 , 154 ].…”

“…3S). Case-fatality rate of HD patients was heterogeneus, ranging from 0 to 47% [ 11 – 13 , 15 , 17 , 19 , 21 , 32 , 62 , 82 , 93 , 108 , 109 , 112 – 121 , 123 – 138 , 143 – 145 , 147 , 148 , 150 , 152 , 154 ] and, as expected, outcome of patients who were admitted to ICU was poor with a mortality accounting for 42.8–100% of cases [ 13 , 21 , 82 , 109 , 114 , 119 , 125 , 126 , 129 , 130 , 154 ].…”

COVID-19 in Immunocompromised Patients: A Systematic Review

“…Studies including immunocompromised outpatients showed high rates of hospitalization (53-86%) across most of the 17,19 Moreover, the latter showed a slightly higher mortality in patients with solid tumors compared with hematological malignancies (37.7 and 23.5%, respectively 17 (►Table 2).…”