Delayed hemodialysis in COVID-19: Case series with literature review.
ACE-2
COVID-19
ESRD
angiotensin II
hemodialysis
Journal
Clinical nephrology. Case studies
ISSN: 2196-5293
Titre abrégé: Clin Nephrol Case Stud
Pays: Germany
ID NLM: 101638685
Informations de publication
Date de publication:
2021
2021
Historique:
received:
13
05
2020
accepted:
09
09
2020
entrez:
18
3
2021
pubmed:
19
3
2021
medline:
19
3
2021
Statut:
epublish
Résumé
Increased incidence of kidney injury has been seen in patients with COVID-19. However, less is known about COVID-19 susceptibility and outcomes in end-stage renal disease (ESRD) patients on hemodialysis (HD). Reduced angiotensin-converting enzyme 2 (ACE-2) from SARS-CoV-2 binding and increased angiotensin II (Ang-II) activity have been suggested as mechanisms for COVID-19 renal pathophysiology. In this case series, we analyzed the data of 3 patients with ESRD who had a delay in receiving their regular HD. Reduced oxygen requirement, resolved hyperkalemia, and normalized fluid status were used for the basis of discharge. Presenting symptoms included fever, dyspnea, and dry cough. Laboratory markers were characteristic for COVID-19, such as lymphopenia, elevated D-dimer, C-reactive protein (CRP), and interleukin 6 (IL-6). All 3 of our reported patients required urgent HD upon admission. However, we report no fatalities in our case series, and our patients did not have a severe course of illness requiring endotracheal intubation. We reviewed COVID-19 pathophysiology and how patients with ESRD on HD may be particularly at risk for infection. New renal failure or ESRD sequelae, such as hyperkalemia, uremic encephalopathy, and fluid overload, can be exacerbated by a delay in receiving HD due to COVID-19 infection. Both direct COVID-19 infection and the challenges this pandemic creates to health care logistics present unique threats to ESRD patients on HD.
Sections du résumé
BACKGROUND
BACKGROUND
Increased incidence of kidney injury has been seen in patients with COVID-19. However, less is known about COVID-19 susceptibility and outcomes in end-stage renal disease (ESRD) patients on hemodialysis (HD). Reduced angiotensin-converting enzyme 2 (ACE-2) from SARS-CoV-2 binding and increased angiotensin II (Ang-II) activity have been suggested as mechanisms for COVID-19 renal pathophysiology.
MATERIALS AND METHODS
METHODS
In this case series, we analyzed the data of 3 patients with ESRD who had a delay in receiving their regular HD. Reduced oxygen requirement, resolved hyperkalemia, and normalized fluid status were used for the basis of discharge.
RESULTS
RESULTS
Presenting symptoms included fever, dyspnea, and dry cough. Laboratory markers were characteristic for COVID-19, such as lymphopenia, elevated D-dimer, C-reactive protein (CRP), and interleukin 6 (IL-6). All 3 of our reported patients required urgent HD upon admission. However, we report no fatalities in our case series, and our patients did not have a severe course of illness requiring endotracheal intubation. We reviewed COVID-19 pathophysiology and how patients with ESRD on HD may be particularly at risk for infection.
CONCLUSION
CONCLUSIONS
New renal failure or ESRD sequelae, such as hyperkalemia, uremic encephalopathy, and fluid overload, can be exacerbated by a delay in receiving HD due to COVID-19 infection. Both direct COVID-19 infection and the challenges this pandemic creates to health care logistics present unique threats to ESRD patients on HD.
Identifiants
pubmed: 33732571
doi: 10.5414/CNCS110240
pmc: PMC7962471
doi:
Types de publication
Journal Article
Langues
eng
Pagination
26-32Informations de copyright
© Dustri-Verlag Dr. K. Feistle.
Références
Diabetes. 2010 Feb;59(2):529-38
pubmed: 19934006
Expert Rev Mol Diagn. 2020 May;20(5):453-454
pubmed: 32297805
Nat Rev Nephrol. 2020 Jun;16(6):311-313
pubmed: 32249840
Kidney Int. 2020 May;97(5):829-838
pubmed: 32247631
Kidney Int. 2000 Oct;58(4):1758-64
pubmed: 11012910
J Pathol. 2004 Jun;203(2):631-7
pubmed: 15141377
J Chin Med Assoc. 2020 Jul;83(7):628-633
pubmed: 32433343
Blood Purif. 2006;24(5-6):569-74
pubmed: 17124425
BMJ. 2020 Mar 26;368:m1091
pubmed: 32217556
Chin J Traumatol. 2018 Feb;21(1):4-10
pubmed: 29398292
Braz J Infect Dis. 2020 Mar - Apr;24(2):180-187
pubmed: 32330437
Arch Intern Med. 2008 Nov 24;168(21):2333-9
pubmed: 19029498
Nephrol Dial Transplant. 2020 May 1;35(5):737-741
pubmed: 32196116
Cell. 2020 Apr 16;181(2):271-280.e8
pubmed: 32142651
Lancet Respir Med. 2020 May;8(5):475-481
pubmed: 32105632
Nephrol Dial Transplant. 2013 Sep;28(9):2287-94
pubmed: 23535224
Immun Ageing. 2012 Sep 12;9(1):19
pubmed: 22971545
JAMA. 2020 May 19;323(19):1881-1883
pubmed: 32301958