Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Mar 25, 2022; 11(2): 58-72
Published online Mar 25, 2022. doi: 10.5527/wjn.v11.i2.58
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
Dimitra Bacharaki, Minas Karagiannis, Aggeliki Sardeli, Panagiotis Giannakopoulos, Vasiliki Zoi, Nikitas Piliouras, Kimon Tzannis, Sophia Lionaki, Nephrology Unit, Department of Internal Medicine, "Attikon" University Hospital, Chaidari 12462, Greece
Dimitra Bacharaki, Minas Karagiannis, Aggeliki Sardeli, Panagiotis Giannakopoulos, Nikitas Piliouras, Kimon Tzannis, Dimitra Kavatha, Anastasia Antoniadou, Demetrios Vlahakos, Sophia Lionaki, Medical School, National and Kapodistrian University of Athens, Athens 15772, Greece
Nikolaos Renatos Tziolos, Dimitra Kavatha, Anastasia Antoniadou, Department of Internal Medicine, "Attikon" University Hospital, Chaidari 12462, Greece
Nikolaos-Achilleas Arkoudis, Nikolaos Oikonomopoulos, Department of Radiology, "Attikon" University Hospital, Chaidari 12462, Greece
Author contributions: Bacharaki D designed the study and wrote the manuscript; Karagiannis M, Sardeli A, and Giannakopoulos P screened for eligibility criteria and performed data collection; Tziolos NR, Zoi N, and Piliouras N did data collection; Arkoudis NA and Oikonomopoulos N collected the radiology data and scoring system; Tzannis K analyzed the data; Kavatha D and Antoniadou A were infectious disease specialists; Vlahakos D supervised the study; Lionaki S contributed to manuscript writing and English language revision.
Institutional review board statement: The study was reviewed and approved by the Scientific Committee of our hospital.
Conflict-of-interest statement: There is no conflict of interest to disclose.
Data sharing statement: All data is available upon reasonable request from the corresponding author at bacharaki@gmail.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitra Bacharaki, MD, PhD, Consultant Physician-Scientist, Nephrology Unit, Department of Internal Medicine, "Attikon" University Hospital, Rimini 1, Chaidari 12462, Greece. bacharaki@gmail.com
Received: October 29, 2021
Peer-review started: October 29, 2021
First decision: December 27, 2021
Revised: January 9, 2022
Accepted: March 23, 2022
Article in press: March 23, 2022
Published online: March 25, 2022
Processing time: 147 Days and 1.9 Hours
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; SARS-CoV-2; Dialysis; Greece; Clinical course; Outcome

Core Tip: Maintenance hemodialysis patients, a group of patients with presumed high mortality, have been reported to experience worse outcomes of coronavirus disease 2019 (COVID-19), compared to the general population internationally. However, there is a considerable variation in the reported rates of disease remission and death between different continents and countries. In this article, we present the outcomes of 32 patients on chronic dialysis who became positive for COVID-19 in the era before vaccines became available.