COVID-19 Infection in Hemodialysis Patients, Incidence, Risk Factors and
Mortality. Single Centre Study

Dileep   Kumar Nanik   Ram; Kashif      Gulzar; Fakhriya      Alalawi; Maseer      Ahmed; Rosa      Manuel; Amna      Alhadari

doi:10.2174/03666220817145707

Abstract

Background: Hemodialysis patients are not only prone to acquire COVID-19 infection but also more likely to suffer a higher rate of morbidity and mortality. This study aims to report the incidence and mortality rate of COVID-19 infection in our hemodialysis patients and to determine risk factors.

Methods: This is an observational, retrospective study conducted in the dialysis unit of Dubai Hospital. Our target population was hemodialysis patients who tested positive for COVID infection (PCR assay of the nasopharyngeal swab) from 1st April 2020 to 31st August 2021. Our primary outcome was to study the mortality rate associated with COVID-19 infection in dialysis patients in Dubai hospital. Our secondary objectives were to study the incidence and determine risk factors for the severity of infection. Patient demographics and clinical features were collected from medical record software, i.e., EPIC. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort.

Results: 72 out of 250 (28.8%) hemodialysis patients acquired COVID infection during the study period, the median age was 54.32 (15-93) years, and 56.94% (n=41) were male. The most common comorbid was hypertension (59.72%), while the main symptom at presentation was shortness of breath (25%). One-third of patients required a different form of oxygen therapy, and 11.11% of patients were mechanically ventilated. The mortality rate was 16.6%. High median age, ischemic heart disease, low absolute lymphocyte count, and high levels of ferritin, LDH, and procalcitonin, as well as mechanical ventilation, were statistically significant risk factors associated with mortality.

Conclusion: The overall outcome of COVID infection in our hemodialysis patients was better compared to the hemodialysis population from other parts of the world.

Keywords: Severe Acute Respiratory Distress Syndrome, HD, ESRD, COVID-19, Novel corona virus, Mortality.

[1]
Kliger AS, Cozzolino M, Jha V, Harbert G, Ikizler TA. Managing the COVID-19 pandemic: International comparisons in dialysis patients. Kidney Int  2020; 98(1): 12-6.
 [http://dx.doi.org/10.1016/j.kint.2020.04.007] [PMID: 32471637]

[2]
Ikizler TA. COVID-19 in dialysis patients: Adding a few more pieces to the puzzle. Kidney Int  2020; 98(1): 17-9.
 [http://dx.doi.org/10.1016/j.kint.2020.04.032] [PMID: 32437767]

[3]
Ma Y, Diao B, Lv X, et al. COVID-19 in hemodialysis (HD) patients: Report from one HD center in Wuhan, China. MedRxiv 2020.
 [http://dx.doi.org/10.1101/2020.02.24.20027201]

[4]
Wang R, Liao C, He H, et al. COVID-19 in hemodialysis patients: A report of 5 cases. Am J Kidney Dis  2020; 76(1): 141-3.
 [http://dx.doi.org/10.1053/j.ajkd.2020.03.009] [PMID: 32240718]

[5]
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet  2020; 395(10223): 497-506.
 [http://dx.doi.org/10.1016/S0140-6736(20)30183-5] [PMID: 31986264]

[6]
Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature  2020; 584(7821): 430-6.
 [http://dx.doi.org/10.1038/s41586-020-2521-4] [PMID: 32640463]

[7]
Kato S, Chmielewski M, Honda H, et al. Aspects of immune dysfunction in end-stage renal disease. Clin J Am Soc Nephrol  2008; 3(5): 1526-33.
 [http://dx.doi.org/10.2215/CJN.00950208] [PMID: 18701615]

[8]
Hsu CM, Weiner DE, Aweh G, et al. COVID-19 among us dialysis patients: Risk factors and outcomes from a national dialysis provider. Am J Kidney Dis  2021; 77(5): 748-756.e1.
 [http://dx.doi.org/10.1053/j.ajkd.2021.01.003] [PMID: 33465417]

[9]
Xiong F, Tang H, Liu L, et al. Clinical characteristics of and medical interventions for COVID-19 in hemodialysis patients in Wuhan, China. J Am Soc Nephrol  2020; 31(7): 1387-97.
 [http://dx.doi.org/10.1681/ASN.2020030354] [PMID: 32385130]

[10]
La Milia V, Bacchini G, Bigi MC, et al. COVID-19 outbreak in a large hemodialysis center in Lombardy, Italy. Kidney Int Rep  2020; 5(7): 1095-9.
 [http://dx.doi.org/10.1016/j.ekir.2020.05.019] [PMID: 32642606]

[11]
Ghonimi TAL, Alkad MM, Abuhelaiqa EA, et al. Mortality and associated risk factors of COVID-19 infection in dialysis patients in Qatar: A nationwide cohort study. PLoS One  2021; 16(7)e0254246
 [http://dx.doi.org/10.1371/journal.pone.0254246] [PMID: 34293004]

[12]
Lano G, Braconnier A, Bataille S, et al. Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort. Clin Kidney J  2020; 13(5): 878-88.
 [http://dx.doi.org/10.1093/ckj/sfaa199] [PMID: 33354330]

[13]
Ng JH, Hirsch JS, Wanchoo R, et al. Outcomes of patients with end-stage kidney disease hospitalized with COVID-19. Kidney Int  2020; 98(6): 1530-9.
 [http://dx.doi.org/10.1016/j.kint.2020.07.030] [PMID: 32810523]

[14]
Goicoechea M, Sánchez Cámara LA, Macías N, et al. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int  2020; 98(1): 27-34.
 [http://dx.doi.org/10.1016/j.kint.2020.04.031] [PMID: 32437770]

[15]
Turgutalp K, Ozturk S, Arici M, et al. Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19. BMC Nephrol  2021; 22(1): 29.
 [http://dx.doi.org/10.1186/s12882-021-02233-0] [PMID: 33446135]

[16]
Kazmi S, Alam A, Salman B, et al. Clinical course and outcome of esrd patients on maintenance hemodialysis infected with COVID-19: A single-center study. Int J Nephrol Renovasc Dis  2021; 14: 193-9.
 [http://dx.doi.org/10.2147/IJNRD.S310035] [PMID: 34234514]

[17]
Jin JM, Bai P, He W, et al. Gender differences in patients with COVID-19: Focus on severity and mortality. Front Public Health  2020; 8: 152.
 [http://dx.doi.org/10.3389/fpubh.2020.00152] [PMID: 32411652]

[18]
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA  2020; 323(11): 1061-9.
 [http://dx.doi.org/10.1001/jama.2020.1585] [PMID: 32031570]

[19]
de Almeida-Pititto B, Dualib PM, Zajdenverg L, et al. Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: A meta-analysis. Diabetol Metab Syndr  2020; 12(1): 75.
 [http://dx.doi.org/10.1186/s13098-020-00586-4] [PMID: 32874207]

[20]
Kong KA, Jung S, Yu M, Park J, Kang IS. Association between cardiovascular risk factors and the severity of coronavirus disease 2019: Nationwide epidemiological study in Korea. Front Cardiovasc Med  2021; 8732518
 [http://dx.doi.org/10.3389/fcvm.2021.732518] [PMID: 34568465]

[21]
Ugwueze CV, Ezeokpo BC, Nnolim BI, Agim EA, Anikpo NC, Onyekachi KE. COVID-19 and diabetes mellitus: The link and clinical implications. Dubai Diabetes Endocrinol J  2020; 26(2): 69-77.
 [http://dx.doi.org/10.1159/000511354]

[22]
Vancheri SG, Savietto G, Ballati F, et al. Radiographic findings in 240 patients with COVID-19 pneumonia: time-dependence after the onset of symptoms. Eur Radiol  2020; 30(11): 6161-9.
 [http://dx.doi.org/10.1007/s00330-020-06967-7] [PMID: 32474630]

[23]
Kiss S, Gede N, Hegyi P, et al. Early changes in laboratory parameters are predictors of mortality and ICU admission in patients with COVID-19: A systematic review and meta-analysis. Med Microbiol Immunol (Berl)  2021; 210(1): 33-47.
 [http://dx.doi.org/10.1007/s00430-020-00696-w] [PMID: 33219397]

[24]
Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med  2020; 382(18): 1708-20.
 [http://dx.doi.org/10.1056/NEJMoa2002032] [PMID: 32109013]

[25]
Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis. j intensive care  2020; 36

[26]
Hsu PP, Sabatini DM. Cancer cell metabolism: Warburg and beyond. Cell  2008; 134(5): 703-7.
 [http://dx.doi.org/10.1016/j.cell.2008.08.021] [PMID: 18775299]

[27]
Henry BM, Aggarwal G, Wong J, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerg Med  2020; 38(9): 1722-6.
 [http://dx.doi.org/10.1016/j.ajem.2020.05.073] [PMID: 32738466]

[28]
Stefan G, Mehedinti AM, Andreiana I, et al. Clinical features and outcome of maintenance hemodialysis patients with COVID-19 from a tertiary nephrology care center in Romania. Ren Fail  2021; 43(1): 49-57.
 [http://dx.doi.org/10.1080/0886022X.2020.1853571] [PMID: 33307933]

[29]
Creamer AW, Kent AE, Albur M. Procalcitonin in respiratory disease: Use as a biomarker for diagnosis and guiding antibiotic therapy. Breathe (Sheff)  2019; 15(4): 296-304.
 [http://dx.doi.org/10.1183/20734735.0258-2019] [PMID: 31803264]

[30]
Song J, Park DW, Moon S, et al. Diagnostic and prognostic value of interleukin-6, pentraxin 3, and procalcitonin levels among sepsis and septic shock patients: A prospective controlled study according to the Sepsis-3 definitions. BMC Infect Dis  2019; 19(1): 968.
 [http://dx.doi.org/10.1186/s12879-019-4618-7] [PMID: 31718563]

[31]
Kamat IS, Ramachandran V, Eswaran H, Guffey D, Musher DM. Procalcitonin to distinguish viral from bacterial pneumonia: A systematic review and meta-analysis. Clin Infect Dis  2020; 70(3): 538-42.
 [http://dx.doi.org/10.1093/cid/ciz545] [PMID: 31241140]

[32]
Hariyanto TI, Japar KV, Kwenandar F, et al. Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis. Am J Emerg Med  2021; 41: 110-9.
 [http://dx.doi.org/10.1016/j.ajem.2020.12.076] [PMID: 33418211]