Abstract
The COVID-19 pandemic has led to frequent referrals to the emergency department on suspicion of this infection in maintenance hemodialysis (MHD) and kidney transplant (KT) patients. We aimed to describe their clinical features comparing confirmed and suspected non-confirmed COVID-19 cases during the Spanish epidemic peak. Confirmed COVID-19 ((+)COVID-19) corresponds to patient with positive RT-PCR SARS-CoV-2 assay. Non-confirmed COVID-19 ((−)COVID-19) corresponds to patients with negative RT-PCR. COVID-19 was suspected in 61 patients (40/803 KT (4.9%), 21/220 MHD (9.5%)). Prevalence of (+)COVID-19 was 3.2% in KT and 3.6% in MHD patients. Thirty-four (26 KT and 8 MHD) were (+)COVID-19 and 27 (14 KT and 13 MHD) (−)COVID-19. In comparison with (−)COVID-19 patients, (+)COVID-19 showed higher frequency of typical viral symptoms (cough, dyspnea, asthenia and myalgias), pneumonia (88.2% vs. 14.3%) and LDH and CRP while lower phosphate levels, need of hospital admission (100% vs. 63%), use of non-invasive mechanical ventilation (36% vs. 11%) and mortality (38% vs. 0%) (p < 0.001). Time from symptoms onset to admission was longer in patients who finally died than in survivors (8.5 vs. 3.8, p = 0.007). In KT and MHD patients, (+)COVID-19 shows more clinical severity than suspected non-confirmed cases. Prompt RT-PCR is mandatory to confirm COVID-19 diagnosis.
Highlights
COVID-19 has spread throughout the world, affecting more than 4.5 million persons since late December 2019 [1,2]
An observational study was planned in all kidney transplant (KT) recipients and maintenance hemodialysis (MHD) patients who were studied in the Hospital del Mar between 12 March 2020 and 21 April 2020 for suspected COVID-19 infection
Fever was the main symptom leading to potential COVID-19
Summary
COVID-19 has spread throughout the world, affecting more than 4.5 million persons since late December 2019 [1,2]. In Spain, most diagnoses have been obtained in symptomatic persons, the number of confirmed cases has increased from 4209 cases by 13 March 2020 [3] to more than 230,000 confirmed cases and 27,650 deaths by early May [4]. Symptoms of COVID-19 are not specific: variable combinations of fever, cough, dyspnea, myalgia and asthenia comprise the usual syndrome at presentation [5,6]. Clinical presentation usually leads to suspicion, which needs confirmation with adequate tests. Identification of patients infected with COVID-19 has important implications for isolation, reduction of the risk of transmission and management. Polymerase chain reaction (PCR) tests for SARS-CoV-2 identify viral ribonucleic acid (RNA) in respiratory tract, and it is considered the “gold standard” for acute infection. Information on the clinical presentation and early evolution is not comprehensive, and studies comparing clinical and analytical presentation and final outcomes between suspected cases with PCR positive and negative are unavailable
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