tetano
Editor, Senior Moderator
J Am Soc Nephrol
. 2020 May 28;ASN.2020040470.
doi: 10.1681/ASN.2020040470. Online ahead of print.
Presentation and Outcomes of Patients With ESKD and COVID-19
Anthony M Valeri[SUP] 1 [/SUP], Shelief Y Robbins-Juarez[SUP] 1 [/SUP], Jacob S Stevens[SUP] 1 2 [/SUP], Wooin Ahn[SUP] 1 [/SUP], Maya K Rao[SUP] 1 [/SUP], Jai Radhakrishnan[SUP] 1 [/SUP], Ali G Gharavi[SUP] 1 [/SUP], Sumit Mohan[SUP] 1 2 3 [/SUP], S Ali Husain[SUP] 4 2 [/SUP]
Affiliations
Abstract
Background: The relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.
Methods: To examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.
Results: Two of the study's 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7?10[SUP]3[/SUP]/μl), as was C-reactive protein (163 versus 80 mg/L).
Conclusions: The association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population.
Keywords: COVID-19; ESRD; Epidemiology and outcomes; coronavirus; dialysis.
. 2020 May 28;ASN.2020040470.
doi: 10.1681/ASN.2020040470. Online ahead of print.
Presentation and Outcomes of Patients With ESKD and COVID-19
Anthony M Valeri[SUP] 1 [/SUP], Shelief Y Robbins-Juarez[SUP] 1 [/SUP], Jacob S Stevens[SUP] 1 2 [/SUP], Wooin Ahn[SUP] 1 [/SUP], Maya K Rao[SUP] 1 [/SUP], Jai Radhakrishnan[SUP] 1 [/SUP], Ali G Gharavi[SUP] 1 [/SUP], Sumit Mohan[SUP] 1 2 3 [/SUP], S Ali Husain[SUP] 4 2 [/SUP]
Affiliations
- PMID: 32467113
- DOI: 10.1681/ASN.2020040470
Abstract
Background: The relative immunosuppression and high prevalence of comorbidities in patients with ESKD on dialysis raise concerns that they may have an elevated risk of severe coronavirus disease 2019 (COVID-19), but outcomes for COVID-19 in such patients are unclear.
Methods: To examine presentation and outcomes of COVID-19 in patients with ESKD on dialysis, we retrospectively collected clinical data on 59 patients on dialysis who were hospitalized with COVID-19. We used Wilcoxon rank sum and Fischer exact tests to compare patients who died versus those still living.
Results: Two of the study's 59 patients were on peritoneal dialysis, and 57 were on hemodialysis. Median age was 63 years, with high prevalence of hypertension (98%) and diabetes (69%). Patients who died were significantly older than those still living (median age, 75 versus 62 years) and had a higher median Charlson comorbidity index (8 versus 7). The most common presenting symptoms were fever (49%) and cough (39%); initial radiographs most commonly showed multifocal or bilateral opacities (59%). By end of follow-up, 18 patients (31%) died a median 6 days after hospitalization, including 75% of patients who required mechanical ventilation. Eleven of those who died had advanced directives against intubation. The remaining 41 patients (69%) were discharged home a median 8 days after admission. The median initial white blood cell count was significantly higher in patients who died compared with those still living (7.5 versus 5.7?10[SUP]3[/SUP]/μl), as was C-reactive protein (163 versus 80 mg/L).
Conclusions: The association of COVID-19 with high mortality in patients with ESKD on dialysis reinforces the need to take appropriate infection control measures to prevent COVID-19 spread in this vulnerable population.
Keywords: COVID-19; ESRD; Epidemiology and outcomes; coronavirus; dialysis.