A single-center experience: SARS-CoV-2 in ESKRD and kidney transplant patients

Background: A new strain of coronavirus was first recognized in late 2019 resulting in a worldwide pandemic by early 2020. This pandemic challenged health care systems worldwide. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulted in a spectrum of illnesses ranging from asymptomatic, mild, and self-limiting to severe disease. To this date, there are no clear treatment guidelines or protocols for the management of patients in general and for hemodialysis and transplant patients in particular. The Centers for Disease Control and Prevention (CDC) lists patients with chronic kidney disease and immunocompromised patients as high risk for severe disease from SARS-CoV-2. Methods: Our study is a single-center retrospective study. We conducted an observational, retrospective study in ESKD and Kidney transplant recipients hospitalized and diagnosed with COVID-19 disease at Advocate Christ Medical Center admitted between March 1 to May 31, 2020, a 3-month period. We describe our experience in patients with ESKD and kidney transplants during the COVID 19 pandemic. With particular attention to the treatments used, prognosis, and kidney outcomes in these patients. Results: From the aggregate total of patients diagnosed with SARS-COV 2 between March 1 to May 31, 2020, there were 34 patients with ESKD on KRT and 3 kidney transplants. The median age of our ESKD cohort was 63.5 years while the KT cohort was 69 years. For both patient populations were predominantly male with 52.9% for ESKD and 66.7% for KT. With 64.7% of ESKD being composed of African Americans, while our KT patients were predominantly Caucasian at 66.7%. The average length of hospital stay was longer for KT patients at an average of 22 days. The incidence of in-hospital death was significantly higher in ESKD patients at 27.8% while we had no mortality for KT pts. For in-patient mortality serum Na, K and BUN were not statistically significant from those who survived. D-dimer peak was significantly higher in mortality. Conclusions: COVID-19 infection is associated with a high rate of mortality amongst patient's with pre-existing End Stage Kidney Disease. This study redemonstrates this high mortality rate at a single center institution. More research is needed in understanding and managing these patients.