Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China

Abstract

Background: Reports indicate that those most vulnerable to developing severe coronavirus disease 2019 (COVID-19) are older adults and those with underlying illnesses, such as diabetes mellitus, hypertension, or cardiovascular disease, which are common comorbidities among patients undergoing maintenance hemodialysis. However, there is limited information about the clinical characteristics of hemodialysis patients with COVID-19 or about interventions to control COVID-19 in hemodialysis centers.

Methods: We collected data retrospectively through an online registration system that includes all patients receiving maintenance hemodialysis at 65 centers in Wuhan, China. We reviewed epidemiologic and clinical data of patients with laboratory-confirmed COVID-19 between January 1, 2020 and March 10, 2020.

Results: Of 7154 patients undergoing hemodialysis, 154 had laboratory-confirmed COVID-19. The mean age of the 131 patients in our analysis was 63.2 years; 57.3% were men. Many had underlying comorbidities, with cardiovascular disease (including hypertension) being the most common (68.7%). Only 51.9% of patients manifested fever; 21.4% of infected patients were asymptomatic. The most common finding on chest computed tomography (CT) was ground-grass or patchy opacity (82.1%). After initiating comprehensive interventions-including entrance screening of body temperature and symptoms, universal chest CT and blood tests, and other measures-new patients presenting with COVID-19 peaked at 10 per day on January 30, decreasing to 4 per day on February 11. No new cases occurred between February 26 and March 10, 2020.

Conclusions: We found that patients receiving maintenance hemodialysis were susceptible to COVID-19 and that hemodialysis centers were high-risk settings during the epidemic. Increasing prevention efforts, instituting universal screening, and isolating patients with COVID-19 and directing them to designated hemodialysis centers were effective in preventing the spread of COVID-19 in hemodialysis centers.

Keywords: COVID-19; Clinical characteristics; Interventions; hemodialysis.

Copyright © 2020 by the American Society of Nephrology.

Figures

Figure 1.

Flow chart illustrating study population selection. Jan, January; Mar, March.

Figure 2.

Chest CT scan images of representative patients. (A) Transverse chest CT scan images from an 82-year-old woman who was critically ill showing bilateral ground-glass opacity and consolidation with interlobular septal thickening on day 5 after symptom onset. (B) Transverse chest CT scan image from a 63-year-old man with severe pneumonia showing bilateral multiple ground-glass opacity on day 5 after symptom onset. (C) Transverse chest CT scan image from a 58-year-old woman with only cough showing unilateral ground-glass opacity on day 3 after symptom onset. (D–F) Transverse chest CT scan images from an asymptomatic 53-year-old man showing (D) unilateral ground-glass opacity and consolidation on day 0, (E) decreased density of ground-glass opacity on day 8, and (F) a roughly normal image on day 17 after a positive nucleic acid result. (G and H) Summarized data of (G) CT scan image features and (H) lesion regions of mild/moderate and severe/critical patients.

Figure 3.

The onset of, and medical interventions implemented to prevent the spread of, COVID-19 among hemodialysis patients in Wuhan up until March 10, 2020.