Characteristics of COVID‒19 in hemodialysis patients

Abstract

［Objective］Little is known about the clinical courses of hemodialysis patients with COVID‒19. We examined the characteristics of COVID‒19 in hemodialysis patients.［Materials and Methods］We enrolled 33 hemodialysis patients with COVID‒19 and 174 non‒hemodialysis patients with COVID‒19 who were admitted to our hospital in this study. We compared the clinical course of COVID‒19 between the hemodialysis and non‒hemodialysis patients. Among the hemodialysis patients with COVID‒19, we also compared the laboratory data of the severe and non‒severe groups.［Results］While 44.4％ of the hemodialysis patients were treated with steroids, only 13.2％ of the non‒hemodialysis patients received steroid treatment (p＜0.001). Among the patients who were not treated with steroids, it took 10.3±3.2 days for fevers to resolve in the hemodialysis patients, which was significantly longer than in the non‒hemodialysis patients (8.0±3.6 days, p＝0.034). In addition, it took 31.1±7.3 days for the hemodialysis patients to become PCR‒negative, which was significantly longer than it took in the non‒hemodialysis patients (21.7±4.4 days, p＝0.016). The mortality rate among the dialysis patients was 12.1％, whereas none of the non‒hemodialysis patients died. The hemodialysis patients had a significantly worse prognosis than the non‒hemodialysis patients (p＜0.001). Of the 4 deaths, thrombosis was suspected to be the cause of death in 2 cases. In a comparison between the severe and non‒severe cases, high C‒reactive protein (CRP) and D‒dimer levels and leukocyte counts and low lymphocyte ratios were seen in the severe group.［Conclusion］Among COVID‒19 patients, more hemodialysis patients than non‒hemodialysis patients required steroid therapy. In the hemodialysis patients, it took longer for fevers to resolve and for PCR tests to become negative, and they also had worse prognoses. In COVID‒19 patients, clinicians should pay attention not only to the deterioration of oxygen saturation, but also to the risk of sudden death due to thrombosis. It may be necessary to pay attention to disease severity in patients with high CRP levels, white blood cell counts, or D‒dimer levels, or low lymphocyte ratios.