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COVID-19 in Patients on Maintenance Dialysis in the Paris Region
Sarah Tortonese1, Ivan Scriabine1, Louis Anjou1
1Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Le Kremlin Bicêtre, France.
Insights
Coronavirus disease 2019 (COVID-19) severely impacts patients on maintenance dialysis. Key indicators of mortality in these patients include cough, low thrombocyte count, elevated lactate dehydrogenase, and high C-reactive protein levels.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) poses a significant threat to individuals undergoing maintenance dialysis.
- The clinical presentation, mortality rates, and prognostic factors for COVID-19 in dialysis patients were not well-established prior to this study.
Purpose of the Study:
- To investigate the clinical characteristics, outcomes, and prognostic factors of COVID-19 in patients receiving maintenance dialysis.
- To identify predictors of mortality in this vulnerable patient population.
Main Methods:
- A retrospective review of medical records was conducted for all patients on maintenance dialysis diagnosed with COVID-19 between March 11 and April 11, 2020.
- Data were collected and analyzed up to a specified cutoff date of May 11, 2020.
Main Results:
- Forty-four dialysis patients with COVID-19 were identified, with a median age of 61. Hypertension and diabetes were prevalent comorbidities.
- A high proportion (93.2%) required hospitalization, and 75% needed oxygen therapy, with 45.5% admitted to the intensive care unit.
- The overall mortality rate was 27.3%. Multivariate analysis identified cough, thrombopenia (<120 g/l), elevated lactate dehydrogenase (LDH), and high C-reactive protein (CRP) (>175 mg/l) as significant predictors of death.
Conclusions:
- A significant COVID-19 outbreak occurred among maintenance dialysis patients in the Paris region.
- COVID-19 is particularly severe in patients on maintenance dialysis, with identifiable prognostic markers for mortality.
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.
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