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Nephrol Dial Transplant ; 35(8): 1338-1411, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871594

RESUMO

BACKGROUND: There are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death. METHODS: All HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes. RESULTS: Among 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66-83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0-5), 7 (4-11) and 32 (26.5-35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25-106) and 690 Ly/µL (IQR 450-960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11-3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005-1.017); P < 0.0001]. CONCLUSIONS: HD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.


Assuntos
Betacoronavirus/genética , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/epidemiologia , DNA Viral/análise , Falência Renal Crônica/epidemiologia , Pneumonia Viral/epidemiologia , Diálise Renal/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , COVID-19 , Comorbidade , Infecções por Coronavirus/sangue , Feminino , França/epidemiologia , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pandemias , Pneumonia Viral/sangue , Estudos Prospectivos , SARS-CoV-2 , Taxa de Sobrevida/tendências
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