Clinical Features of Maintenance Hemodialysis Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

Abstract

Background and objectives: Previous reports on the outbreak of coronavirus disease 2019 were on the basis of data from the general population. Our study aimed to investigate the clinical features of patients on maintenance hemodialysis.

Design, setting, participants, & measurements: In this retrospective, single-center study, we included 49 hospitalized patients on maintenance hemodialysis and 52 hospitalized patients without kidney failure (controls) with confirmed coronavirus disease 2019 at Tongren Hospital of Wuhan University from January 30, 2020 to March 10, 2020. Demographic, clinical, laboratory, and radiologic characteristics and treatment and outcomes data were analyzed. The final date of follow-up was March 19, 2020.

Results: The median age of 101 patients was 62 years (interquartile range, 49-72). All patients were local residents of Wuhan. In terms of common symptoms, there were differences between patients on hemodialysis and controls (fatigue [59% versus 83%], dry cough [49% versus 71%], and fever [47% versus 90%]). Lymphocyte counts were decreased (0.8×109/L [patients on hemodialysis] versus 0.9×109/L [controls], P=0.02). Comparing patients on hemodialysis with controls, creatine kinase-muscle and brain type, myoglobin, hypersensitive troponin I, B-type natriuretic peptide, and procalcitonin were increased, and the percentage of abnormalities in bilateral lung was higher in computed tomographic scan (82% versus 69%, P=0.15) and unilateral lung was lower (10% versus 27%, P=0.03). Common complications including shock, acute respiratory distress syndrome, arrhythmia, and acute cardiac injury in patients on hemodialysis were significantly higher. Compared with controls, more patients on hemodialysis received noninvasive ventilation (25% versus 6%, P=0.008). As of March 19, 2020, three patients on hemodialysis (6%) were transferred to the intensive care unit and received invasive ventilation. Seven patients on hemodialysis (14%) had died.

Conclusions: The main symptoms of coronavirus disease 2019 pneumonia, including fever and cough, were less common in patients on hemodialysis. Patients on hemodialysis with coronavirus disease 2019 were at higher risk of death.

Keywords: Coronavirus; OVID-19; kidney failure; maintenance hemodialysis; severe acute respiratory syndrome coronavirus 2.

Copyright © 2020 by the American Society of Nephrology.

Figures

Graphical abstract

Figure 1.

Chest computed tomographic (CT) scan images of two patients on hemodialysis infected with severe acute respiratory syndrome coronavirus 2. (A) Right-sided pathy consolidation and ground-glass opacities on admission. Expansion of pulmonary lesions, with enlargement of consolidations in right lung and appearance of ground-glass opacities in left lung after 4 days. Parts of consolidations being dissipated into ground-glass opacities in right lung, with enlargement of ground-glass opacities in left lung after 15 days. Resolution of the lesions in left and right lungs after 5 days. (B) Bilateral ground-glass opacities and consolidations on admission. Expansion of pulmonary lesions, with enlargement of bilateral ground-glass opacities and consolidations after 9 days. Bilateral consolidations being resolved in left and right lungs after 10 days. Further resolution of the lesions after 5 days. Two patients were discharged.

Figure 2.

Chest CT scan images of two patients without kidney failure infected with severe acute respiratory syndrome coronavirus 2. (A) Bilateral consolidations and ground-glass opacities on admission. Bilateral consolidations being resolved in left and right lungs after 5 days. Further resolution of the lesions after 6 days. (B) Right-sided ground-glass opacities and consolidation and slight ground-glass opacities in left lung on admission. Resolution of the lesions in right lung and slight consolidation in left lung after 7 days. Further resolution of the lesions in right and left lungs after 4 days. Two patients were discharged.

Figure 3.

Chest CT scan images of a patient on hemodialysis infected with severe acute respiratory syndrome coronavirus 2. There were no obvious abnormal radiologic findings on admission. Extensive ground-glass opacities can be seen in right lung after 7 days. The patient was dead.