The Spectrum of Clinical and Serological Features of COVID-19 in Urban Hemodialysis Patients

被引:22
作者
da Cunha, Teresa Stock [1 ]
Goma-Garces, Elena [1 ]
Avello, Alejandro [1 ]
Pereira-Garcia, Monica [2 ]
Mas-Fontao, Sebastian [3 ,4 ]
Ortiz, Alberto [1 ,5 ,6 ]
Gonzalez-Parra, Emilio [1 ,5 ,6 ]
机构
[1] Fdn Jimenez Diaz, Nephrol & Hypertens Dept, Madrid 28040, Spain
[2] Inigo Alvarez de Toledo Renal Fdn FRIAT, Madrid 28040, Spain
[3] UAM, Renal Vasc & Diabet Res Lab, Fdn Jimenez Diaz, IIS, Madrid 28040, Spain
[4] Spanish Biomed Res Ctr Diabet & Associated Metab, Madrid 28040, Spain
[5] Spanish Renal Res Network REDinREN, Madrid 28040, Spain
[6] Univ Autonoma Madrid UAM, UAM Med Sch, Madrid 28040, Spain
关键词
COVID-19; hemodialysis; chronic kidney disease; antibodies; asymptomatic; mortality; HIGH PREVALENCE; MORTALITY; RISK;
D O I
10.3390/jcm9072264
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: The inherent immunosuppression of uremia increases the susceptibility of hemodialysis patients to infection. There is still limited evidence on hemodialysis patients and COVID-19. The clinical and analytical spectrum and treatment responses and mortality are poorly characterized. Material and Methods: Clinical and analytical features, chest X-ray, polymerase chain reaction (PCR) and antibodies for SARS-CoV-2, treatment and outcomes were analyzed in 48 patients diagnosed with COVID-19 during March and April 2020 in two coordinated Spanish hemodialysis units. Results: In 200 haemodialysis patients, COVID-19 was diagnosed in 48, of whom 22 were PCR positive, eight PCR negative but seroconverted and two were diagnosed on typical clinical grounds. Despite a mean age of 72.6 years, the overall mortality rate was 5/48 (10%). Among the PCR positive patients, 21 (55%) required admission and five (13%) died. PCR positive patients were more often symptomatic and hospitalized and had higher troponin I levels than PCR negative patients, but did not differ in lymphocyte counts, D-dimer or interleukin-6 (IL-6) levels. Among PCR negative COVID-19 patients, three out of 10 (30%) required admission, and none died. The most frequent symptom among the 48 patients was fever (31%), followed by asymptomatic patients (23%). A low number of lymphocytes was the only parameter significantly different between hospitalized and ambulatory COVID-19 patients, independently of PCR status. Conclusions: COVID-19 hemodialysis patients are frequently asymptomatic, and mortality may be lower than previously reported. Diagnosis may be retrospective, based on seroconversion, as PCR may be negative. This information should guide preventive and patient isolation strategies.
引用
收藏
页码:1 / 12
页数:12
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