Does end stage renal disease increase severity of COVID-19?
Keywords:COVID-19, ESRD, SARS-CoV-2, Ct-value, NLR
Background: End stage renal disease (ESRD) patients are vulnerable to contract corona virus disease-19 (COVID-19), and they have higher risk of deterioration and mortality rate compared to general population. There are studies on COVID-19 in end stage renal disease (ESRD) patients showing the low rates of deterioration, most of which did not develop into severe pneumonia.
Objective: Compare the clinical, laboratory, and radiological findings in COVID-19 patients with and without ESRD and to identify the mortality risk factors in those with ESRD.
Methods: We conducted a cross-sectional study involving 87 COVID-19 patients, consisted of 43 ESRD and 44 non-ESRD. Data taken included age, gender, the amount of co-morbid, oxygen saturation when they first arrived, COVID 19 symptoms (mild/moderate/severe-critical), and the data of patients who died.
Result: Severe-critical clinical manifestations of COVID-19 were more common in those with ESRD vs those without (p=0.012). However, the mortality was not significantly different. Absolute neutrophil count and neutrophil-lymphocyte ratio (NLR) were significantly higher in those with ESRD. As many as 24% COVID patients died, in which 11% are ESRD patients, and 13% non-ESRD. Multivariate analysis showed that NLR ≥1 had 1.3 times higher death risk compared to NLR<1.
Conclusion: Severe-critical clinical manifestations of COVID-19 were more commonly found in ESRD patients. The mortality rate was not significantly different between the ESRD and non-ESRD. In COVID-19 patients with ESRD, NLR ≥1 had 1.3 times higher death risk compared to NLR<1. High NLR is a risk factor for higher mortality in ESRD patients.
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497–506.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Articles Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan , China : a retrospective cohort study. Lancet [Internet]. 2020;6736(20):1–9. Available from: http://dx.doi.org/10.1016/S0140-6736(20)30566-3
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061–9.
Wang X, Fang X, Cai Z, Wu X, Gao X, Min J, et al. Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis. Res (Washington, DC). 2020;2020:2402961.
Lano G, Braconnier A, Bataille S, Cavaille G, Moussi-Frances J, Gondouin B, et al. Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort. Clin Kidney J. 2020 Oct;13(5):878–88.
States U, August F, Ziemba R, Campbell KN, Yang T, Schaeffer SE, et al. Excess Death Estimates in Patients with End-Stage Renal Disease —. 2021;70(22):825–9.
Hsu CM, Weiner DE. COVID-19 in dialysis patients: outlasting and outsmarting a pandemic. Vol. 98, Kidney international. 2020. p. 1402–4.
Alalwan AA, Taher A, Alaradi AH, Complex SM. A Hemodialysis Patient with Severe COVID-19 Pneumonia. 2020;12(5).
Chan L, Jaladanki SK, Somani S, Paranjpe I, Kumar A, Zhao S, et al. Outcomes of Patients on Maintenance Dialysis Hospitalized with COVID-19. Vol. 16, Clinical journal of the American Society of Nephrology : CJASN. 2021. p. 452–5.
Ma Y, Diao B, Lv X, Zhu J, Chen C, Liu L, et al. Epidemiological, Clinical, and Immunological Features of a Cluster of COVID-19–Contracted Hemodialysis Patients. Kidney Int Reports. 2020;5(8):1333–41.
Ikizler TA. COVID-19 in dialysis patients: adding a few more pieces to the puzzle. Vol. 98, Kidney international. 2020. p. 17–9.
Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Vol. 52, International urology and nephrology. 2020. p. 1193–4.
D’Marco L, Puchades MJ, Romero-Parra M, Gimenez-Civera E, Soler MJ, Ortiz A, et al. Coronavirus disease 2019 in chronic kidney disease. Clin Kidney J. 2020 Jun;13(3):297–306.
Kooman JP, van der Sande FM. COVID-19 in ESRD and Acute Kidney Injury. Blood Purif. 2021;50(4–5):610–20.
Ma Y, Diao B, Lv X, Zhu J, Liang W, Liu L, et al. 2019 novel coronavirus disease in hemodialysis (HD) patients: Report from one HD center in Wuhan, China. medRxiv [Internet]. 2020 Jan 1;2020.02.24.20027201. Available from: http://medrxiv.org/content/early/2020/02/27/2020.02.24.20027201.abstract
Marshall DL, Bois F, Jensen SKS, Linde SA, Higby R, Rémy-McCort Y, et al. Sentinel Coronavirus environmental monitoring can contribute to detecting asymptomatic SARS-CoV-2 virus spreaders and can verify effectiveness of workplace COVID-19 controls. Microb Risk Anal. 2020;16:100137.
Ahmed W, Angel N, Edson J, Bibby K, Bivins A, Brien JWO, et al. Science of the Total Environment First con fi rmed detection of SARS-CoV-2 in untreated wastewater in Australia : A proof of concept for the wastewater surveillance of COVID- 19 in the community. Sci Total Environ [Internet]. 2020;728:138764. Available from: https://doi.org/10.1016/j.scitotenv.2020.138764
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Mar;382(13):1199–207.
Cheng VCC, Wong S-C, Chen JHK, Yip CCY, Chuang VWM, Tsang OTY, et al. Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020 May;41(5):493–8.
Cozzi D, Albanesi M, Cavigli E, Moroni C, Bindi A, Luvarà S. Chest X ‑ ray in new Coronavirus Disease 2019 ( COVID ‑ 19 ) infection : findings and correlation with clinical outcome. Radiol Med [Internet]. 2020;125(8):730–7. Available from: https://doi.org/10.1007/s11547-020-01232-9
Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea. Korean J Radiol. 2020 Apr;21(4):494–500.
Ying H-Q, Deng Q-W, He B-S, Pan Y-Q, Wang F, Sun H-L, et al. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol. 2014 Dec;31(12):305.
Creput C, Fumeron C, Toledano D, Diaconita M, Izzedine H. COVID-19 in Patients Undergoing Hemodialysis: Prevalence and Asymptomatic Screening During a Period of High Community Prevalence in a Large Paris Center. Kidney Med. 2020;2(6):716-723.e1.
Yang A-P, Liu J-P, Tao W-Q, Li H-M. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020 Jul;84:106504.
How to Cite
Copyright (c) 2023 Jurnal Penyakit Dalam Udayana
This work is licensed under a Creative Commons Attribution 4.0 International License.
The copyright to this article is transferred to JPD (including without limitation, the right to publish the work in whole or in part in any and all forms of media, now or hereafter known) effective if and when the article is accepted for publication thus granting JPD all rights for the work so that both parties may be protected from the consequences of unauthorized use.
The copyright transfer covers the exclusive right to reproduce and distribute the article, including reprints, translations, photographic reproductions, microform, electronic form (offline,online) or any other reproductions of similar nature.
The authors warrant that their contribution is an original work not published elsewhere, that they have the full power to make this grant and that the article contains no matter unlawful or which invades the right to privacy or infringes any proprietary right.