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COVID-19 in Grade 4-5 Chronic Kidney Disease Patients
Silvia Collado1, María Dolores Arenas1, Francesc Barbosa1
1Department of Nephrology, Hospital del Mar, Barcelona, Spain.
Insights
Coronavirus disease (COVID-19) can affect patients with advanced chronic kidney disease (CKD). Prompt supportive care may lead to acceptable outcomes for these high-risk individuals, with most remaining dialysis-free post-infection.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Chronic kidney disease (CKD) is a known risk factor for mortality in patients with coronavirus disease 2019 (COVID-19).
- Limited data exists on COVID-19's impact on non-dialysis-dependent advanced CKD patients.
- Dialysis patients have shown high incidence and severity of COVID-19.
Observation:
- Seven patients with stage 4-5 CKD and symptomatic COVID-19 were analyzed.
- Patients presented with fever, cough, and dyspnea; five had bilateral pneumonia.
- Two patients required non-invasive mechanical ventilation, and all experienced kidney function decline.
Findings:
- No patients required acute dialysis, and six were discharged alive and remained dialysis-free.
- One 76-year-old patient died.
- The estimated glomerular filtration rate (eGFR) declined below 5 mL/min in six cases during admission.
Implications:
- COVID-19 can affect advanced CKD patients, but prognosis can be favorable with timely supportive interventions.
- Further research with larger cohorts is needed to validate these findings.
- Understanding the full clinical spectrum and optimal treatment strategies for COVID-19 in advanced CKD is crucial.
Introduction:
Chronic kidney disease (CKD) increases the risk of mortality during coronavirus disease 2019 (COVID-19) episodes, and some reports have underlined the high incidence and severity of this infection in dialysis patients. Information on COVID-19 in nondialysis CKD patients is not available yet.
Case Reports:
Here we present 7 patients with grade 4-5 CKD who developed symptomatic COVID-19; they comprise 2.6% of our 267 advanced CKD patients. The estimated GFR was between 12 and 20 mL/min during the month prior to COVID-19. The 3 major symptoms were fever, cough, and dyspnea, and 5 patients showed bilateral pneumonia. Hydroxychloroquine, azithromycin, ceftriaxone, and steroids were the most frequently prescribed drugs. Two patients needed noninvasive mechanical ventilation. All patients showed minimal to moderate kidney function deterioration during admission, with an eGFR decline below 5 mL/min in 6 cases. No patient required acute dialysis. Six patients were discharged alive and remained dialysis free athe t the time of reporting, and one 76-year-old patient died.
Conclusions:
COVID-19 affects grade 4-5 CKD patients, but prognosis may be acceptable if prompt supportive measures are applied. These findings should be confirmed in larger cohorts, and further observations will be needed to understand the full spectrum of clinical features and the optimal approach to COVID-19 in patients with advanced CKD.
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