COVID-19 in Patients on Maintenance Dialysis in the Paris Region

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) represents a serious threat to patients on maintenance dialysis. The clinical setting, mortality rate, and prognostic factors in these patients have not been well established.

Methods: We included all dialyzed patients with COVID-19 referred to our dialysis center between March 11 and April 11, 2020. Data were obtained through the review of the medical records and were censored at the time of data cutoff, on May 11, 2020.

Results: Forty-four patients on maintenance dialysis with COVID-19 were referred to our dialysis unit during the COVID-19 epidemic. Median age was 61 years (interquartile range [IQR]: 51.5-72.5); 65.9% were men. Comorbidities included hypertension (97.7%), diabetes mellitus (50%), and chronic cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (79.5%), shortness of breath (29.5%), cough (43.2%), and diarrhea (13.6%). Three profiles of severity were distinguished based on the World Health Organization (WHO) progression scale. Forty-one (93.2%) were hospitalized and only 3 were maintained on outpatient hemodialysis. Thirty-three (75%) patients required oxygen therapy, including 15 (45.5%) who were referred to the intensive care unit. Overall, 27.3% of patients died, and 58.5% were discharged from hospital, including only 2 (13.3%) of those admitted to the intensive care unit. By multivariate analysis, cough, thrombopenia <120 g/l, lactate dehydrogenase (LDH) level greater than 2 times the upper limit of normal, and blood C-reactive protein (CRP) >175 mg/l were significantly associated with death.

Conclusion: A major outbreak of COVID-19 occurred in the Paris region, and spread among dialyzed patients. Our study underscores the severity of COVID-19 in these patients and identified prognostic markers.

Keywords: COVID-19; coronavirus; hemodialysis; kidney; peritoneal dialysis.

Figure 1

Cumulative incidence of COVID-19 dialyzed patients referred to the in-hospital dialysis unit of Bicêtre University Hospital (APHP).

Figure 2

Comparison of main laboratory data between admission and worst value by World Health Organization (WHO) score group. (a) Hemoglobin level (g/dl) on admission (Hbadm) and minimum (Hbmin) value during hospitalization. (b) Lymphocyte count (g/l) on admission (Lymphadm) and minimum (Lymphmin) value during hospitalization. (c) Platelet count (g/l) on admission (Platadm) and minimum (Platmin) value during hospitalization. (d) Blood C-reactive protein level (mg/l) on admission (CRPadm) and maximum (CRPmax) value during hospitalization. (e) Lactate dehydrogenases level (UI/l) on admission (LDHadm) and maximum (LDHmax) value during hospitalization.

Figure 3

Overall severity by World Health Organization (WHO) progression scale and impact on mortality.

Figure 4

Kaplan-Meier survival curves of significant covariates associated with death by multivariate analysis. Hazard ratios (HR) and 95% confidence intervals (CI) are detailed after adjustment for age. CRP, C-reactive protein; LDH, lactate dehydrogenase.