COVID-19 in Patients Undergoing Hemodialysis: Prevalence and Asymptomatic Screening During a Period of High Community Prevalence in a Large Paris Center

Caroline Creput; Christine Fumeron; Daniel Toledano; Mirela Diaconita; Hassan Izzedine

doi:10.1016/j.xkme.2020.09.001

COVID-19 in Patients Undergoing Hemodialysis: Prevalence and Asymptomatic Screening During a Period of High Community Prevalence in a Large Paris Center

Kidney Med. 2020 Nov-Dec;2(6):716-723.e1. doi: 10.1016/j.xkme.2020.09.001. Epub 2020 Oct 22.

Authors

Caroline Creput¹, Christine Fumeron¹, Daniel Toledano¹, Mirela Diaconita¹, Hassan Izzedine²

Affiliations

¹ Nephrology and Hemodialysis Unit, Diaverum, Paris, France.
² Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France.

Abstract

Rationale & objective: Due to extensive comorbid conditions, coronavirus disease 2019 (COVID-19) has a poor prognosis in people receiving maintenance hemodialysis. In this article, we describe our experience with 200 maintenance hemodialysis patients in a hemodialysis center that used universal reverse transcriptase-polymerase chain reaction testing, including 38 COVID-19-positive patients.

Study design: Descriptive observational cohort, including the time line of patient diagnoses along with contextual events including precautions, testing, screening algorithms, clinical diagnostics and therapy, and the clinical course of COVID-19-infected patients and their final outcomes.

Setting & participants: 200 patients within a single hemodialysis center with 2 dialysis clinics in Paris.

Results: Among 200 maintenance hemodialysis patients, 38 (19%) had COVID-19 diagnosed; of these, 15 (39.5%) were admitted to the hospital, including 4 who required intensive care unit (ICU) care. There were 8 (21%) deaths. The most common symptom was fever, followed by dry cough, fatigue, and dyspnea. All COVID-19-infected patients had lymphopenia and an increase in C-reactive protein levels. Median time from the onset of respiratory symptoms to ICU admission was 1 to 2 days. Durations of non-ICU hospitalizations and ICU stays were 7 and 13 days, respectively.

Limitations: Retrospective study, single hemodialysis center.

Conclusions: Dialysis patients are a highly susceptible population and hemodialysis centers are a high-risk area in a COVID-19 epidemic. "Unexplained" lymphopenia and/or an increase in C-reactive protein level should lead physicians to the diagnosis of COVID-19 and should, when possible, be followed by diagnostic testing with universal reverse transcriptase-polymerase chain reaction, as well as the reinforcement of contamination barrier measures.

Keywords: COVID-19; coronavirus disease 2019; end-stage kidney disease; hemodialysis; mortality.