COVID-19 in chronic hemodialysis patients: A report of 9 cases in Madrid, Spain.

INTRODUCTION: In December 2019, a new respiratory disease, named COVID-19, caused by a novel coronavirus, emerged in Wuhan and since then spread rapidly throughout China and worldwide. Hemodialysis patients are an especially vulnerable subgroup of the general population. However, there are only a few reports on the course of COVID-19 in maintenance hemodialysis patients. CASE REPORT: We describe in depth the clinical, analytical, and radiological details of 9 hemodialysis patients from a single center in Madrid (Spain) diagnosed with COVID-19. Furthermore, we describe and discuss the therapeutic aspects and the patients' outcomes. DISCUSSION: We present one of the first case series of chronic hemodialysis patients with COVID-19. Between March 14 and April 8, 2020, out of 76 prevalent patients in our hemodialysis unit, 9 (11.8%) patients were diagnosed with COVID-19. The most common symptoms were fever (77.8%), asthenia (77.8%), cough (55.6%), and dyspnea (33.3%). A total of 3 patients developed severe pneumonia, whereas 4 patients developed mild pneumonia. In 2 patients, no pathologic changes were found on chest radiography. All patients presented lymphopenia. While 6 (66.7%) patients required hospitalization, none of them was admitted to intensive care unit. The most common treatments used were azithromycin (100%), hydroxychloroquine (66.7%), lopinavir/ritonavir (55.6%) and ß-interferon (22.2%). In general, we observed a mild to moderate severity of disease in our case series. One patient died, however due to a cause not related to COVID-19.

Manejo de un paciente con trasplante renal en terapia de mantenimiento con COVID-19 en un hospital no trasplantador. Reporte de caso / Management of a maintenance renal transplant patient with COVID-19, in a non-transplant hospital

Resumen La enfermedad por SARS-CoV-2 (COVID-19) ha aumentado drásticamente desde marzo 2020 y en la actualidad no existen datos suficientes para establecer el riesgo de contagio de este virus en receptores de trasplante renal en comparación con la población general. El objetivo de este reporte de caso fue presentar las características del curso clínico y terapéutico de una paciente trasplantada renal en terapia de mantenimiento que presentó neumonía por COVID-19 y fue atendida en un hospital no trasplantador. La paciente era una mujer de 47 años con antecedente de insuficiencia renal no filiada que recibió trasplante renal de donante por muerte encefálica en el año 2006. Las características clínicas (síntomas, exámenes de laboratorio e imágenes radiológicas) de la mujer fueron similares a las de otros pacientes con COVID-19 de la población general, por lo que fue tratada con hidroxicloroquina, lopinavir/ritonavir, antibioticoterapia profiláctica y dosis única de tocilizumab. La triple terapia inmunosupresora de mantenimiento que recibía se discontinuó al no poder monitorizar los niveles sanguíneos de algunos fármacos inmunosupresores; asimismo se indicaron dosis bajas de metilprednisolona y 5 dosis de flebogama. La neumonía por COVID-19 en esta paciente inmunodeprimida evolucionó favorablemente sin necesidad de respiración mecánica asistida, y la función renal mejoró a sus valores basales, mantenien- do moderada proteinuria. Al alta se reinició la dosis previa de su medicación inmunosupresora habitual. La experiencia descrita en el presente caso puede ser útil para en tratamiento de pacientes trasplantados y con COVID-19 en hospitales no trasplantadores y que no disponen de la capacidad de verificar los niveles de medicación inmunosupresora.

Abstract SARS-CoV-2 disease (COVID-19) has dramatically increased since March 2020. There is insufficient data to establish the risk of acquiring the infection in kidney transplant recipients in comparison with the general population. The objective of this case is to report here the clinical features and therapeutic course of the renal transplant recipient with confirmed COVID-19 pneumonia in a non-transplant hospital. This is a 47-year-old woman with end stage renal disease (ESRD) of unknown cause who received kidney transplantation 14 years ago. Her clinical characteristics (symptoms, laboratory test results, and chest x-ray images) were similar to those of non-transplanted COVID-19 patients. She was treated with hydroxychloroquine, lopinavir/ritonavir, prophylactic antibiotic therapy, and a single dose of tocilizumab for COVID-19. The triple maintenance immunosuppressive therapy she was receiving was temporarily suspended due to the inability to monitor immunosuppressive drugs levels in our hospital, and low dose methylprednisolone plus five doses of flebogamma were administered instead. The COVID-19 pneumonia in this long-term immunosuppressed patient was successfully recovered without the need to assisted mechanical respiration. The renal function improved to its baseline values, maintaining moderate proteinuria. At discharge, the previous dose of his usual immunosuppressive medication was restarted. We conclude that the experience described with our case may be useful for non-transplant hospitals, which do not have the capacity to perform immunosuppressive medication titration.

Inusual caso de Hiponatremia aguda grave en paciente con Infección por COVID-19 / No disponible

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