SARS-CoV-2 infection in dialysis patients in northern Italy: a single-centre experience

Abstract

Background. Dialysis patients are considered at high risk for COVID-19 and the infection can easily spread in dialysis units.Methods. We conducted an observational single-centre cohort study to describe clinical characteristics, treatments and outcomes of dialysis patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We tested patients who presented symptoms or had contact with a confirmed case. We enrolled 15 patients positive for SARS-CoV-2.Results. We tested 37 of 306 dialysis patients. Patients with SARS-CoV-2 infection were older (mean age 75.96 6 11.09 years) and all had comorbidities. At presentation, most had interstitial infiltrates on chest X-ray, three-quarters had leucopenia and none had respiratory insufficiency. During follow-up, there was an increase in serum C-reactive protein and interleukin-6. Eighty percent of patients received supplemental oxygen; none received non-invasive ventilation, one was intubated. Most patients (80%) were treated with oral hydroxychloroquine for a median time of 6.5 days [interquartile range (IQR) 5-14.5] and 40% received azithromycin; two patients received a short course of antivirals and one received a single dose of tocilizumab. Only two patients did not require hospitalization. Of the nine survivors, eight still tested positive for SARS-CoV-2 a median of 19 days (IQR 9.25-23) after diagnosis. Six patients died (case fatality rate 40%) a median of 5.5 days (IQR 1.75-9.75) after diagnosis. The main reported cause of death was respiratory failure related to COVID-19 (five patients).Conclusions. We report a single-centre experience of SARS-CoV-2 infection in dialysis patients. The disease showed a high case fatality rate and most patients required hospitalization. Survivors show prolonged viral shedding.

Machine Learning for Prediction of Patients on Hemodialysis with an Undetected SARS-CoV-2 Infection

“…Individual predictions can be further used to identify the risk level for dialysis clinics through the proportion of patients classified with an undetected SARS-CoV-2 infection. We anticipate using a Considering the possibility of prolonged viral shedding observed in the general and dialysis populations (40)(41)(42), the optimal period for isolation of dialysis patients affected by COVID-19 appears to be longer than 14 days (42). In countries or areas with testing limitations, especially those with a high positive-tonegative testing ratio (e.g.…”

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

“…In a large HD facility in Northern Italy, the prevalence of infection was 5.21% with a fatality rate of 23.8% 3 . In the city of Modena (Northern Italy), we recorded six fatal infections (mortality rate of 40%) among 280 patients on maintenance dialysis 7 …”

“…The infection principally involves the respiratory tract and manifests with atypical pneumonia, evolving in acute respiratory distress syndrome and sepsis in the most severe form 1 . There is little information about the outcome of patients with chronic kidney disease 2‐7 . Patients on renal replacement therapy are the most vulnerable for SARS‐CoV‐2 infection, as they are old and have a high burden of multiple comorbidities.…”

„Coronavirus-disease-2019“-Pandemie aus nephrologischer Perspektive

“…Die Letalität der COVID-19-Dialysepatienten in Deutschland war im Sommer 2020 mit über 20 %, bezogen auf die Anzahl der an COVID-19 erkrankten Dialysepatienten, sehr hoch und auf einem mit anderen Industrienationen vergleichbaren Niveau [9][10][11][12][13][14][15][16][17]…”