Bacharaki D, Karagiannis M, Sardeli A, Giannakopoulos P, Tziolos NR, Zoi V, Piliouras N, Arkoudis NA, Oikonomopoulos N, Tzannis K, Kavatha D, Antoniadou A, Vlahakos D, Lionaki S. Clinical presentation and outcomes of chronic dialysis patients with COVID-19: A single center experience from Greece . World J Nephrol 2022; 11(2): 58-72 [PMID: 35433341 DOI: 10.5527/wjn.v11.i2.58]
Corresponding Author of This Article
Dimitra Bacharaki, MD, PhD, Consultant Physician-Scientist, Nephrology Unit, Department of Internal Medicine, "Attikon" University Hospital, Rimini 1, Chaidari 12462, Greece. bacharaki@gmail.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
Coronavirus disease 2019 (COVID-19) pandemic runs as mild upper respiratory infection or being asymptomatic in 80% of infected patients, 15% develop severe lung disease, and 5% progress to respiratory failure or septic shock. Mortality ranges from 2%-50%.
Research motivation
Τo analyze our experience with patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (MHD) with COVID-19 before the era of vaccination.
Research objectives
To identify predictors of worst outcome in patients with ESKD on MHD with COVID-19 in the era prior to vaccination, and to study all the range of clinical pictures of COVID-19 in this group of patients, including asymptomatic to severe cases all from a single center.
Research methods
This was a retrospective cohort study from a single referral center from April to February 2021. We examined the kinetics of laboratory evolution of certain parameters linked to COVID-19 pathophysiology, as potential prognostication markers of adverse outcome. Patients were scored according to the WHO severity system for COVID-19 and frailty index, besides classic demographics, and co-morbidities. A new simplified scoring system of severity (Covid Visual Assessment score, CoVAsc) was used.
Research results
Thirty-two hospitalized MHD patients with COVID-19 were studied, from admission to outcome. Although initial presentation was mild on admission regarding WHO severity (16 with mild disease, 13 with moderate, and 3 with severe) and CoVAsc score (24 patients had 0-10% lung infiltrates), the outcome was quite adverse. Approximately 40.6% of patients progressed to severe disease and 15.5% died. “Progressors” tended to have a more “inflamed” laboratory profile at the time of admission and statistically significant higher neutrophils to lymphocytes ratio during the first 10 d of hospitalization. The deceased differed from “survivors” with statistical significance as having a worse WHO severity score, frailty index, and CoVASc score and regarding the first 10-d kinetics of lactate dehydrogenase (increase), D-dimers (increase), and albumin (decrease).
Research conclusions
Traditional risk factors for adverse COVID-19 outcome including male gender and comorbidities do not seem to apply in MHD patients. Potential new clinical indicators of adverse outcome, according to our findings, include the WHO severity score, frailty index, CoVASc score, and the 10-d kinetics of certain laboratory parameters.
Research perspectives
A larger number of dialysis patients might be studied especially after vaccination and the evolving various mutations of SARS-CoV-2.
