Abstract
During the outbreak of Middle East respiratory syndrome coronavirus(MERS-CoV) in 2015, one hemodialysis patient was infected with MERS-CoV, and the remaining hemodialysis(HD) patients (n = 83) and medical staff (n = 12) had to undergo dialysis treatment in an isolated environment. This study was performed to investigate the effects of stress caused by dialysis treatment under isolation. Plasma samples from the HD patients and medical staff were collected at the time of isolation(M0), the following month(M1), and three months after isolation(M3). Parameters for stress included circulating cell-free genomic DNA(ccf-gDNA), circulating cell-free mitochondria DNA(ccf-mtDNA), and pentraxin-3(PTX-3). Decreased values of Hct, kt/v and ca x p were recovered after the end of two weeks of isolation. The levels of ccf-gDNA and ccf-mtDNA were the highest at M0 and decreased gradually in both HD patients and the medical staff. The normalization of ccf-gDNA and ccf-mtDNA was significantly delayed in HD patients compared with the response in the medical staff. PTX-3 increased only in HD patients and was highest at M0, and it then gradually decreased. Medical isolation and subnormal quality of care during the MERS outbreak caused extreme stress in HD patients. Plasma cell-free DNA and PTX-3 seems to be good indicators of stress and quality of care in HD patients.
Highlights
The HD unit was the principal location for the propagation of MERS infections in 2013 in Saudi Arabia[1]
The indoxyl sulfate (IS) level was not decreased at M0-M1
The delta value of ccf-gDNA between M0 and M1 and between M1 and M3 was not different between HD patients and medical staff. These results indicated that stress was sufficient to increase ccf-gDNA levels both in HD patients and medical staff
Summary
The HD unit was the principal location for the propagation of MERS infections in 2013 in Saudi Arabia[1]. The 83 HD patients and 12 medical staff were exposed to the MERS patient. No additional patients were infected with MERS-CoV, but all HD patients and medical staff experienced extreme physical and mental stress for the 17 days of isolation. Pentraxin-3 (PTX-3) is a marker of systemic inflammation producing rapidly by various cells under the inflammation or stress conditions[9]. These three parameters are commonly used as stress parameters in pathologic status. This study was designed to confirm our hypothesis that MERS isolation could affect clinico-laboratory findings and various stress markers including circulating cf-DNA and PTX-3
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