Novel coronavirus infection and hemodialysis: course and predictors of unfavorable outcome

Abstract

In the context of the COVID-19 pandemic, patients with end-stage CKD receiving hemodialysis replacement therapy (HD) were at risk of SARS-CoV-2 infection due to the specifics of treatment and the immunodeficiency state caused by uremia. The aim of the study was to analyze the characteristics of the course, prognostically unfavorable factors, and outcome of COVID-19 in HD patients of the second wave of the pandemic. Materials and methods: a retrospective study was carried out on the material of observations of 325 HD patients infected with SARS-CoV-2 in the period from 09/01/2020 to 12/31/2020. The patients' age was 60.1±14.0 years. The duration of HD treatment was 30.0 (9.5;66.0) months. The endpoint was taken as the discharge from the hospital or death. Results: in 264 out of 325 (81.2%) patients, the diagnosis of COVID-19 was confirmed by the identification of SARS-CoV-2 RNA. CT scan of the chest showed signs of viral pneumonia in all patients. Mortality was 15.1% (49 out of 325 pts). In 79.7% of patients, the cause of death was ARDS. Comparative analysis showed that patients with a fatal outcome (group 2) were older (69.2±10.6 years) than patients with a successful course (group 1) of the disease (58.5±13.9 years), and differed in higher comorbidity index (7.8±1.9 versus 5.9±2.2, respectively). SpO2 in groups 2 and 1 was 65.2±10.1% and 92.1±6.4%, respectively (p<0.001). In the deceased patients, anemia, leukocytosis, thrombocytopenia, and hypoalbuminemia were significantly more pronounced, as well as indicators of GGT, alkaline phosphatase, ferritin, CRP, LDH, and D-dimer. In the fatal group, the proportion of patients with a procalcitonin level of more than 2 ng/ml was also higher. In multivariate analysis, only high comorbidity index and the need for mechanical ventilation were the independent predictors of the unfavorable outcome. In the group of patients with the favorable outcome, the combined therapy with immunobiological drugs and dexamethasone were used significantly more often than in the deceased group, while the frequency of their “isolated” use in the compared groups was comparable. Conclusions: COVID-19 in HD patients is characterized by severe course and high mortality. Independent predictors of an unfavorable outcome of the disease were a high comorbidity index and the need for invasive lung ventilation. Early use of immunobiological drugs and dexamethasone in combination with anticoagulants increases the effectiveness of treatment of severe forms of SARS-CoV-2 infection in HD patients. © 2021 JSC Vidal Rus. All rights reserved.