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Observational Study
. 2020 Aug 1;35(8):1338-1411.
doi: 10.1093/ndt/gfaa170.

Impact of first-wave COronaVIrus disease 2019 infection in patients on haemoDIALysis in Alsace: the observational COVIDIAL study

Nicolas Keller  1 , François Chantrel  2   3 , Thierry Krummel  1 , Dorothée Bazin-Kara  1 , Anne Laure Faller  4   5 , Clotilde Muller  4   5 , Thimothée Nussbaumer  6   7 , Manfred Ismer  6   7 , Abdellatif Benmoussa  8 , Mohamed Brahim-Bouna  8 , Stéphanie Beier  5 , Peggy Perrin  9 , Theirry Hannedouche  1   5
Affiliations
Observational Study

Impact of first-wave COronaVIrus disease 2019 infection in patients on haemoDIALysis in Alsace: the observational COVIDIAL study

Nicolas Keller et al. Nephrol Dial Transplant. .

Abstract

Background: There are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death.

Methods: All HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes.

Results: Among 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66-83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0-5), 7 (4-11) and 32 (26.5-35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25-106) and 690 Ly/µL (IQR 450-960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11-3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005-1.017); P < 0.0001].

Conclusions: HD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.

Keywords: COVID-19; epidemiology; haemodialysis; mortality.

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Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival curves in HD patients after onset of symptoms and according to CRP quartile.
See this image and copyright information in PMC

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