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Clinical presentation and outcomes of chronic dialysis patients with COVID-19: A single center experience from Greece
Dimitra Bacharaki1, Minas Karagiannis1, Aggeliki Sardeli1
1Nephrology Unit, Department of Internal Medicine, "Attikon" University Hospital, Chaidari 12462, Greece.
Insights
Maintenance hemodialysis patients face higher COVID-19 mortality. Frailty, CT scans, WHO scores, LDH, D-dimers, and albumin predict mortality, while neutrophil counts predict disease progression.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) poses a significant threat, particularly to vulnerable populations.
- Maintenance hemodialysis (MHD) patients exhibit higher morbidity and mortality rates from COVID-19 compared to the general population.
Purpose of the Study:
- To investigate the clinical course and outcomes of hospitalized COVID-19 patients undergoing maintenance hemodialysis.
- To identify predictors of mortality and disease progression in this patient cohort.
Main Methods:
- Retrospective observational study at a single center in Greece.
- Analysis of clinical, laboratory, and radiological data correlated with patient outcomes.
- Diagnosis confirmed via real-time polymerase chain reaction (PCR).
Main Results:
- Thirty-two maintenance hemodialysis patients were studied (median age 75.5 years).
- The case fatality rate was 15.6% (5/32), with 13 patients classified as "progressors" requiring oxygen.
- Predictors of mortality included frailty, chest CT findings, WHO severity score, serum LDH, D-dimers, and albumin levels. Neutrophil counts and neutrophil-to-lymphocyte ratio predicted progression.
Conclusions:
- Maintenance hemodialysis patients are at elevated risk for COVID-19 mortality.
- Specific laboratory parameters and clinical factors can aid in risk stratification and management of COVID-19 in MHD patients.
Background:
Coronavirus disease 2019 (COVID-19) is still a menacing pandemic, especially in vulnerable patients. Morbidity and mortality from COVID-19 in maintenance hemodialysis (MHD) patients are considered worse than those in the general population, but vary across continents and countries in Europe.
Aim:
To describe the clinical course and outcomes of hospitalized MHD patients with COVID-19 in a retrospective observational single center study in Greece.
Methods:
We correlated clinical, laboratory, and radiological data with the clinical outcomes of MHD patients hospitalized with COVID-19 during the pandemic. The diagnosis was confirmed by real-time polymerase chain reaction. Outcome was determined as survivors vs non-survivors and "progressors" (those requiring oxygen supplementation because of COVID-19 pneumonia worsening) vs "non-progressors".
Results:
We studied 32 patients (17 males), with a median age of 75.5 (IQR: 58.5-82) years old. Of those, 12 were diagnosed upon screening and 20 with related symptoms. According to the World Health Organization (WHO) score, the severity on admission was mild disease in 16, moderate in 13, and severe in 3 cases. Chest computed tomography (CT) showed 1-10% infiltrates in 24 patients. Thirteen "progressors" were recorded among included patients. The case fatality rate was 5/32 (15.6%). Three deaths occurred among "progressors" and two in "non-progressors", irrespective of co-morbidities and gender. Predictors of mortality on admission included frailty index, chest CT findings, WHO severity score, and thereafter the increasing values of serum LDH and D-dimers and decreasing serum albumin. Predictors of becoming a "progressor" included increasing number of neutrophils and neutrophils/lymphocytes ratio.
Conclusion:
Patients on MHD seem to be at higher risk of COVID-19 mortality, distinct from the general population. Certain laboratory parameters on admission and during follow-up may be helpful in risk stratification and management of patients.
