Trends in fever and respiratory illness in hemodialysis patients during the COVID-19 pandemic

Background: It is unclear whether end-stage kidney disease (ESKD) patients with COVID-19 are at increased risk for adverse outcomes due to impaired immune responses attributable to uremia Alternatively, a weakened immune state could mitigate the cytokine surge observed in non-ESKD patients with COVID-19 The aim of our study is to describe the clinical characteristics and short term outcomes in ESKD patients requiring hospitalization for COVID-19 Methods: We performed a retrospective study of 114 consecutive ESKD patients hospitalized at two major hospitals in the Bronx with COVID-19 from March 9, 2020 to April 12, 2020 in the midst of the coronavirus surge in New York City Clinical and laboratory data were extracted from the medical record and short term outcomes were reported Results: The mean age was 63 years (range 30-87);61 4% were men and 88 6% were Black or Hispanic Most had hypertension (89 5%) and diabetes mellitus 66% and 30 7% were nursing home residents Intensive care unit admission was required in 13(11 4%) patients and 17(14 9%) required mechanical ventilation In-hospital mortality occurred in 23(20%) patients and was similar to mortality observed in non-ESKD patients Mortality was 59% in those who required mechanical ventilation At the time of data censoring, 47% had been discharged and 32% remained hospitalized Initial procalcitonin, ferritin, lactate dehydrogenase and lymphocyte percentage were significantly higher in those who died Conclusions: Short term mortality in Bronx ESKD patients hospitalized with COVID-19 was similar to non-ESKD patients Mechanical ventilation was associated with high mortality Initial elevated inflammatory markers may be predictors of mortality in ESKD patients with COVID-19 To date, this is one of the largest studies describing outcomes in hospitalized ESKD patients with COVID-19 Further studies describing long-term outcomes in this population following COVID-19 are needed