PMC:7464116 / 57080-62589 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7464116","sourcedb":"PMC","sourceid":"7464116","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7464116","text":"7.3. Clinical Features in Patients in Hemodialysis (HD)\nThe ERA-EDTA has created a European database that collects individual data of dialysis patients with COVID-19; in the last update dating back to 23rd July, 5596 cases of COVID-19 and 1331 deaths were reported among hemodialysis patients [118].Patients undergoing dialysis have impaired immune systems and have a high risk of infectious disease. Kwan et al. [119] reported that dialysis patients had a higher rate of contracting SARS compared with an individual from the general population, but both the degree of disease severity and the mortality rate of the dialysis group were similar to the one of the control group. Based on SARS-CoV-2′s sequence similarity with SARS, it is possible that COVID-19 could follow the same trend as the one of SARS in patients undergoing hemodialysis. To understand the clinical features of COVID-19 infection, it is of interest to consider the first multicenter study focused on 7154 patients undergoing long term hemodialysis in 65 centers in Wuhan (China) [120]. Among all patients in HD, 154 had laboratory-confirmed COVID-19 tests with an incidence of COVID-19 infection in 2% of patients, which is much higher than that of the general population. This may be explained with the advanced age of the dialysis population, to the altered immune systems because of their uremic condition and the significant comorbidities that accompany this group, like cardiovascular disease, diabetes and cerebrovascular disease. Among 154 patients with COVID-19, 77% were mild/moderate patients, whilst 23% were severe/critical patients. The primary causes of end stage kidney disease (ESKD) in patients with severe/critical disease were similar to those with mild/moderate disease. The presence of cardiovascular disease was more likely to be present in patients with severe/critical infectious disease than among those with mild/moderate disease. Moreover, there were no significant differences between severe/critical and mild/moderate COVID- 19 infection regarding age, gender, smoking status and complications like diabetes, chronic obstructive pulmonary disease and cancer. The dialysis model, access, frequency of dialysis had no significant effect on the degree of COVID-19 disease severity. The most common symptoms, especially in the severe/critical group, were: fever, cough, fatigue, sputum production, dyspnea, nausea/vomiting, diarrhea and sore throat. An interesting case report of one of the first patients with COVID-19 in ESKD suffering from gastrointestinal (GI) problems highlights the importance of considering other clinical presentations of COVID-19 infection and not just focusing on the typical respiratory symptoms, in order to prevent exposure of potentially affected individuals to the general population. GI symptoms are somewhat unusual and seem to be a delayed clinical presentation of COVID-19 infection [121]. However, some of those symptoms may be difficult to distinguish from uremic symptoms. Diabetic patients showed more likely symptoms when infected. The disease symptoms of hemodialysis patients were similar to those of the general population, but only 50% of them had fever and nearly 25% were asymptomatic over the whole clinical course of COVID-19 infection. Since hemodialysis patients have disorders of B- and T-cell function [122], patients may show atypical clinical presentations. The most common finding on chest computed tomography was ground-grass or patchy opacity. These lesions often involved both the lungs; on the other hand, consolidation in lungs was not common. These radiological findings were similar to those shown in the general population, but sometimes it was difficult to distinguish them from lung changes due to their uremia status or inadequate dialysis.\nData from laboratory tests showed that lymphocytopenia was common in patients described in other reports [26,120], and there was a trend for the decline of lymphocytesin the severe/critical group, which is consistent with the results of other recent clinical reports. The uremic state of these patients is associated with a wide range of impairments in lymphocyte and granulocyte functions; lymphocytopenia is also common in dialysis patients. Considering low lymphocyte counts in chronic hemodialysis patients [108], lymphopenia is unlikely to be helpful for identifying individuals infected by SARS-CoV-2. Procalcitonin levels have similar limitations: in fact, its levels are chronically elevated in hemodialysis patients, even in the absence of severe acute illness. In addition, the majority of patientshad normal white cell and platelet counts. Serum albumin levels were also within the normal range for most of the patients too. Conversely, considering these limitations and the high prevalence of comorbid conditions, COVID-19 pneumonia diagnosis in hemodialysis patients is based on clinical epidemiology, radiographic findings and viral nucleic acid testing [123]. Interestingly, diabetes, as a primary cause of ESKD or a coexisting disorder, was much more common in symptomatic patients affected by COVID-19 and lymphocytopenia was also more severe. In total, about 40% of patients had at least one compromised organ, including cardiac injury, liver dysfunction, ARDS and a cerebrovascular event. Most patients undergoing hemodialysis (HD), who were regularly monitored, showed stable clinical conditions in the course of treatment of COVID-19 and pulmonary inflammation was gradually 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