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Clinical course of patients on maintenance hemodialysis and COVID-19: a retrospective longitudinal study
Guan-Nan Jin1, Ze-Yang Ding2,3, Gan-Xun Li2
1Department of Nephrology, Union Hosptial, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei, China.
Insights
Outcomes for Coronavirus Disease 2019 (COVID-19) patients on maintenance hemodialysis (MHD) are critical. Non-survivors showed higher inflammatory markers like CRP and IL-6, suggesting immune dysregulation contributes to poor prognosis in these patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus Disease 2019 (COVID-19) is a global pandemic with limited data on patients undergoing maintenance hemodialysis (MHD).
- Understanding the clinical course and outcomes of MHD patients with COVID-19 is crucial for patient management.
Purpose of the Study:
- To analyze the clinical features and outcomes of maintenance hemodialysis patients hospitalized with COVID-19.
- To identify factors associated with mortality in this vulnerable patient population.
Main Methods:
- Retrospective longitudinal study of 19 maintenance hemodialysis patients with COVID-19 admitted to Wuhan Tongji Hospital.
- Comparison of baseline characteristics, clinical courses, laboratory findings, and marker trajectories between survivors and non-survivors.
Main Results:
- Out of 19 MHD patients with COVID-19, 6 (31.6%) died and 13 (68.4%) were discharged.
- Non-survivors exhibited significantly higher levels of C-reactive protein (CRP), Interleukin-6 (IL-6), procalcitonin, and fibrinogen compared to survivors.
Conclusions:
- Immune response dysregulation and coagulation abnormalities are implicated in the severe pathology of COVID-19 among maintenance hemodialysis patients.
- These factors may contribute to the observed poor prognosis in MHD patients with COVID-19.
Abstract:
Coronavirus Disease 2019 (COVID-19) emerges as a global pandemic and there is a lack of evidence about the clinical course and outcome of patients on maintenance hemodialysis (MHD). Here we conducted a retrospective longitudinal study aimed to analyze the clinical features and outcome of MHD patients hospitalized with COVID-19. Of 3126 inpatients with COVID-19 at 3 Branches of Wuhan Tongji Hospital from Jan 18th to Mar 9th, 2020, 19 patients were undergoing maintenance hemodialysis. Among the 19 MHD patients with COVID-19, 6 patients (31.6%) died, and 13 patients (68.4%) were able to be discharged. Baseline characteristics, clinical courses, laboratory findings, and dynamic trajectories of major laboratory markers were compared between survivors and nonsurvivors. According to our findings, MHD patients with COVID-19 who experienced non-surviving outcome had more elevated CRP, IL6 and procalcitonin as well as fibrinogen levels at various points compared to survivors. Thus the dysregulation of immune response as well as coagulation abnormalities might be highly involved in the pathological process of COVID-19, contributing to the poor prognosis in MHD patients.
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