Clinical presentation and outcomes of chronic dialysis patients with COVID-19: A single center experience from Greece

Dimitra Bacharaki; Minas Karagiannis; Aggeliki Sardeli; Panagiotis Giannakopoulos; Nikolaos Renatos Tziolos; Vasiliki Zoi; Nikitas Piliouras; Nikolaos-Achilleas Arkoudis; Nikolaos Oikonomopoulos; Kimon Tzannis; Dimitra Kavatha; Anastasia Antoniadou; Demetrios Vlahakos; Sophia Lionaki

doi:10.5527/wjn.v11.i2.58

Clinical presentation and outcomes of chronic dialysis patients with COVID-19: A single center experience from Greece

World J Nephrol. 2022 Mar 25;11(2):58-72. doi: 10.5527/wjn.v11.i2.58.

Authors

Affiliations

¹ Nephrology Unit, Department of Internal Medicine, "Attikon" University Hospital, Chaidari 12462, Greece.
² Department of Internal Medicine, "Attikon" University Hospital, Chaidari 12462, Greece.
³ Department of Radiology, "Attikon" University Hospital, Chaidari 12462, Greece.
⁴ Medical School, National and Kapodistrian University of Athens, Athens 15772, Greece.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is still a menacing pandemic, especially in vulnerable patients. Morbidity and mortality from COVID-19 in maintenance hemodialysis (MHD) patients are considered worse than those in the general population, but vary across continents and countries in Europe.

Aim: To describe the clinical course and outcomes of hospitalized MHD patients with COVID-19 in a retrospective observational single center study in Greece.

Methods: We correlated clinical, laboratory, and radiological data with the clinical outcomes of MHD patients hospitalized with COVID-19 during the pandemic. The diagnosis was confirmed by real-time polymerase chain reaction. Outcome was determined as survivors vs non-survivors and "progressors" (those requiring oxygen supplementation because of COVID-19 pneumonia worsening) vs "non-progressors".

Results: We studied 32 patients (17 males), with a median age of 75.5 (IQR: 58.5-82) years old. Of those, 12 were diagnosed upon screening and 20 with related symptoms. According to the World Health Organization (WHO) score, the severity on admission was mild disease in 16, moderate in 13, and severe in 3 cases. Chest computed tomography (CT) showed 1-10% infiltrates in 24 patients. Thirteen "progressors" were recorded among included patients. The case fatality rate was 5/32 (15.6%). Three deaths occurred among "progressors" and two in "non-progressors", irrespective of co-morbidities and gender. Predictors of mortality on admission included frailty index, chest CT findings, WHO severity score, and thereafter the increasing values of serum LDH and D-dimers and decreasing serum albumin. Predictors of becoming a "progressor" included increasing number of neutrophils and neutrophils/lymphocytes ratio.

Conclusion: Patients on MHD seem to be at higher risk of COVID-19 mortality, distinct from the general population. Certain laboratory parameters on admission and during follow-up may be helpful in risk stratification and management of patients.

Keywords: COVID-19; Clinical course; Dialysis; Greece; Outcome; SARS-CoV-2.