Clinical Features of 2009 Pandemic Infuenza A (H1N1) Virus Infection in Chronic Hemodialysis Patients

Abstract

Background/Aims: Infection is one of the most common complications and is considered the second leading cause of death in dialysis patients with end-stage renal disease. After the first cases of 2009 pandemic influenza A (H1N1) virus in China became public, persons with suspected infection and those who were in contact with persons with suspected infection were tested. Whether the presentation and clinical course of H1N1 influenza is similar in the dialysis population to the general population is currently unknown. Hemodialysis patients in whom an infection was confirmed were hospitalized and quarantined, and patients on chronic hemodialysis were closely observed for the purpose of investigating the nature and duration of the disease. Methods: From May 2009 to February 2010, we observed 15 hemodialysis patients infected with the 2009 pandemic influenza A (H1N1) virus who were quarantined in Beijing Chao-Yang Hospital, Capital Medical University. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing was used to confirm infection, the clinical features of the disease were closely monitored. Results: The mean age of the 15 patients was 47.6 years, and 9 of the 15 patients were male. The diagnoses were all made in the hospital. All of the 15 patients had fluid overload. The median incubation period of the virus in hemodialysis patients was 4 days (range: 1–7 days). The most common symptoms were dyspnea (in all of the 15 patients) and productive cough (in all of the 15 patients). One of the 15 patients had low-grade fever, and the other 14 patients were afebrile. Lymphopenia, which was common in 12 of the patients, typically occurred on day 2 (range: days 1–3) and resolved by day 9 (range: days 7–11). Hypoxemia was observed in all of the patients. Six of the 15 patients developed respiratory failure requiring mechanical ventilation on days 7–9 because they were complicated by Escherichia coli nosocomial pneumonia. All the patients were placed in respiratory isolation and were treated with oseltamivir. The median length of time during which patients had positive real-time RT-PCR test results was 12 days (range: 7–19 days), which was longer than that in general population. Conclusions: The presentation and clinical course of H1N1 influenza A in the hemodialysis patients was atypical and relatively serious, which differed from the general population in China. Furthermore, these patients may have an extended period of viral shedding.