Outcomes Following Hemodialysis with Hemoperfusion in Children with End-stage Kidney Disease and Moderate-to-severe COVID-19

Abstract

Background: SARS-CoV-2 infection became a pandemic in the early part of 2020, affecting individuals of all ages. Patients with end-stage kidney disease (ESKD) with COVID-19 are at higher risk for morbidity and mortality. While studies support the use of hemoperfusion (HP) in patients with COVID-19, data on its use in pediatric patients are scarce and conflicting. Objectives: The objective of this study was to determine the clinical outcomes of pediatric patients with ESKD and moderate-to-severe COVID-19 who underwent hemodialysis with HP in a tertiary subspecialty hospital in Metro Manila. Methods: This retrospective cohort study included all patients with ESKD < 19 years of age admitted at the National Kidney and Transplant Institute from March 1, 2020, to March 1, 2022, on presenting with moderate-to-severe COVID-19. Data were collected through a chart review of medical records. Inflammatory markers and chest radiographs were performed at baseline and repeated after 1–4 sessions of HP. Clinical outcomes were determined in terms of discharge, duration of hospital stay, resolution of symptoms, progression of disease severity of COVID-19, and final outcome as death or discharge. Results: In eight patients who underwent the combined sessions of hemodialysis and HP, serum levels of C-reactive protein, erythrocyte sedimentation rate, lactate dehydrogenase, and ferritin insignificantly decreased after 2–3 sessions; the decline in procalcitonin was significant after the second session (P = 0.046). Findings of pneumonia on chest radiography decreased across all sessions. All patients showed clinical resolution of symptoms and were discharged. Conclusions: Two to three sessions of hemodialysis and HP appear to be safe in improving the clinical status of patients with ESKD and moderate-to-severe COVID-19. The combined use of these modalities can be a useful adjunct to conventional management after maximizing supportive and medical management.