Abstract
IntroductionThe clinical impact of COVID‐19 has not been established in the dialysis population. We evaluated the trajectories of clinical and laboratory parameters in hemodialysis (HD) patients.MethodsWe used data from adult HD patients treated at an integrated kidney disease company who received a reverse transcription polymerase chain reaction (RT‐PCR) test to investigate suspicion of a severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection between May 1 and September 1, 2020. Nonparametric smoothing splines were used to fit data for individual trajectories and estimate the mean change over time in patients testing positive or negative for SARS‐CoV‐2 and those who survived or died within 30 days of first suspicion or positive test date. For each clinical parameter of interest, the difference in average daily changes between COVID‐19 positive versus negative group and COVID‐19 survivor versus nonsurvivor group was estimated by fitting a linear mixed effects model based on measurements in the 14 days before (i.e., Day −14 to Day 0) Day 0.ResultsThere were 12,836 HD patients with a suspicion of COVID‐19 who received RT‐PCR testing (8895 SARS‐CoV‐2 positive). We observed significantly different trends (p < 0.05) in pre‐HD systolic blood pressure (SBP), pre‐HD pulse rate, body temperature, ferritin, neutrophils, lymphocytes, albumin, and interdialytic weight gain (IDWG) between COVID‐19 positive and negative patients. For COVID‐19 positive group, we observed significantly different clinical trends (p < 0.05) in pre‐HD pulse rate, lymphocytes, neutrophils, and albumin between survivors and nonsurvivors. We also observed that, in the group of survivors, most clinical parameters returned to pre‐COVID‐19 levels within 60–90 days.ConclusionWe observed unique temporal trends in various clinical and laboratory parameters among HD patients who tested positive versus negative for SARS‐CoV‐2 infection and those who survived the infection versus those who died. These trends can help to define the physiological disturbances that characterize the onset and course of COVID‐19 in HD patients.
Highlights
The clinical impact of COVID-19 has not been established in the dialysis population
There were 12,836 HD patients with a suspicion of COVID-19 who received reverse transcription polymerase chain reaction (RT-PCR) testing (8895 COVID-19 positive and 3941 COVID-19 negative patients) between 01 May 01 and September 01, 2020
The linear mixed effects model estimated the daily change in pre-HD systolic blood pressure (SBP) during the 14 days before Day 0 and identified the COVID-19 positive group had an average decrease of À0.3 mmHg/day; this was distinct compared to the average increase of 0.2 mmHg/day found in the COVID-19 negative group (p < 0.0001) (Table 2)
Summary
The clinical impact of COVID-19 has not been established in the dialysis population. We evaluated the trajectories of clinical and laboratory parameters in hemodialysis (HD) patients. We observed significantly different trends (p < 0.05) in pre-HD systolic blood pressure (SBP), preHD pulse rate, body temperature, ferritin, neutrophils, lymphocytes, albumin, and interdialytic weight gain (IDWG) between COVID-19 positive and negative patients. For COVID-19 positive group, we observed significantly different clinical trends (p < 0.05) in pre-HD pulse rate, lymphocytes, neutrophils, and albumin between survivors and nonsurvivors. During the first half of 2020, there were over 11,200 COVID-19 hospitalizations among Medicare beneficiaries undergoing dialysis in the United States.[7] Various parameters such as pulse, body temperature, C-reactive protein (CRP), and lymphocyte counts at presentation were found to be associated with COVID-19 mortality in kidney failure.[4] the incubation time has not been clearly defined and patients may be infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and potentially infectious weeks before presentation with symptoms. Distinct differences in trajectories of clinical and laboratory parameters before the start of kidney replacement therapy have been shown for patients who survived versus died during the first year on hemodialysis (HD).[9]
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