Nephrology (Carlton)


. 2020 Aug 10.
doi: 10.1111/nep.13767. Online ahead of print.
Clinical benefits of Tocilizumab in COVID-19-related cytokine release syndrome in a patient with end-stage kidney disease on haemodialysis in Australia


Shiny Stephen 1 2 , Yeung-Ae Park 1 2 , Anastasia Chrysostomou 1 3 4



Affiliations

Abstract

COVID-19 remains a global pandemic with more than ten million cases and half a million deaths worldwide. The disease manifestations in patients with chronic kidney disease and especially those on haemodialysis are still being understood, with only a few overseas case series, and small observational trials thus far. It appears the disease is more severe in this patient cohort. 1 (1) 1 1 Part of the pathophysiology of severe COVID-19 is related to accompanying cytokine release syndrome. Tocilizumab, an interleukin-6 inhibitor, has been trialled for treatment of cytokine release syndrome in COVID-19, but not yet approved. We present a case of an Australian patient on long-term haemodialysis with severe COVID-19 who was successfully treated with Tocilizumab. The peak of her illness was on day 7, with a C-reactive protein of 624 mg/L (reference <5 mg/L), ferritin of 5293 ng/mL (reference 30-500 ng/mL), and interleukin-6 level 1959.7 pg/mL, consistent with cytokine release syndrome. She was severely hypoxic on a ventilator, with rising inotropic requirements. With the use of Tocilizumab there was a significant and immediate response in her inflammatory markers, and she made a steady recovery. The patient was discharged home six weeks after presentation.

Keywords: Coronavirus; Cytokine release syndrome; Dialysis; Interleukin-6; Kidney failure, chronic.