Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort
Guillaume Lano, Antoine Braconnier, Stanislas Bataille, Guilhem Cavaille, Julie Moussi-Frances, Bertrand Gondouin, Pascal Bindi, Magued Nakhla, Janette Mansour, Pascale Halin, Bénédicte Levy, Eric Canivet, Khaled Gaha, Isabelle Kazes, Natacha Noel, Alain Wynckel, Alexandre Debrumetz, Noemie Jourde-Chiche, Valerie Moal, Romain Vial, Violaine Scarfoglière, Mickael Bobot, Marion Gully, Tristan Legris, Marion Pelletier, Marion Sallee, Stephane Burtey, Philippe Brunet, Thomas Robert, Philippe Rieu
Clinical Kidney Journal, doi:10.1093/ckj/sfaa199
Background. Coronavirus disease 2019 (COVID-19) is an emerging infectious disease, related to severe acute respiratory syndrome coronavirus 2 infection. Few data are available in patients with end-stage renal disease (ESRD). Methods. We conducted an observational cohort study of COVID-19 patients at 11 dialysis centres in two distinct districts of France to examine the epidemiological and clinical characteristics of COVID-19 in this population, and to determine risk factors of disease severity (defined as a composite outcome including intensive care unit admission or death) and mortality. Results. Among the 2336 patients enrolled, 5.5% had confirmed COVID-19 diagnosis. Of the 122 patients with a follow-up superior to 28 days, 37% reached the composite outcome and 28% died. Multivariate analysis showed that oxygen therapy on diagnosis and a decrease in lymphocyte count were independent risk factors associated with disease severity and with mortality. Chronic use of angiotensin II receptor blockers (ARBs) (18% of patients) was associated with a protective effect on mortality. Treatment with azithromycin and hydroxychloroquine (AZT/HCQ) (46% of patients) were not associated with the composite outcome and with death in univariate and multivariate analyses. Conclusions. COVID-19 is a severe disease with poor prognosis in patients with ESRD. Usual treatment with ARBs seems to be protective of critical evolution and mortality. There is no evidence of clinical benefit with the combination of AZT/HCQ.
SUPPLEMENTARY DATA Supplementary data are available at ckj online.
AUTHORS' CONTRIBUTIONS G.L., A.B., T.R. and P.R. conceived and designed the study, and drafted the manuscript. S.Bataille, G.C., J.M.-F., B.G., P.Bindi, M.N., J.M., P.H., B.L., E.C., K.G., I.K., N.N., A.W., A.D., N.J.-C., V.M., R.V., V.S., M.B., M.G., T.L., M.P., M.S., S.Burtey and P.Brunet were involved in data collection analysis and provided guidance. All authors critically revised the manuscript for important intellectual content and approved the final version for publication.
CONFLICT OF INTEREST STATEMENT All the authors declare that they have no conflict of interest.
References
Alberici, Delbarba, Manenti, A report from the Brescia renal COVID task force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection, Kidney Int
Alhenc-Gelas, Drueke, Blockade of SARS-CoV-2 infection by recombinant soluble ACE2, Kidney Int
Arslan H, Musabak, Soy, Incidence and immunologic analysis of coronavirus disease (COVID-19) in hemodialysis patients: a single-center experience, Exp Clin Transplant
Basile, Combe, Pizzarelli, Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres, Nephrol Dial Transplant
Bataille, Pedinielli, Bergounioux, Could ferritin help the screening for COVID-19 in hemodialysis patients?, Kidney Int
Fosbøl, Butt, Østergaard, Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality, JAMA
Gautret, Lagier, Parola, Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: a pilot observational study, Travel Med Infect Dis
Goicoechea, Sa ´nchez Ca ´mara, COVID-19: clinical course and outcomes of 36 maintenance hemodialysis patients from a single center in Spain, Kidney Int
Grasselli, Zangrillo, Zanella, for the COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy, JAMA
Henry, Lippi, Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection, Int Urol Nephrol
Hoffmann, Kleine-Weber, Schroeder, SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor, Cell
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan China, Lancet
Mackey, King, Gurley, Risks and impact of angiotensin-converting enzyme inhibitors or angiotensinreceptor blockers on SARS-CoV-2 infection in adults: a living systematic review, Ann Int Med
Mancia, Rea, Ludergnani, Renin-angiotensin-aldosterone system blockers and the risk of covid-19, N Engl J Med
Marco, Puchades, Romero-Parra, Coronavirus disease 2019 in chronic kidney disease, Clin Kidney J
Michaud, Deodhar, Arwood, ACE2 as a therapeutic target for COVID-19; its role in infectious processes and regulation by modulators of the RAAS system, J Clin Med
Milia, Bacchini, Bigi, COVID-19 outbreak in a large hemodialysis center in Lombardy, Italy, Kidney Int Rep
Salje, Kiem, Lefrancq, Estimating the burden of SARS-CoV-2 in France, Science
Sparks, South, Welling, Sound science before quick judgement regarding RAS blockade in COVID-19, Clin J Am Soc Nephrol
Stock Da Cunha, Goma, ´s, Avello, The spectrum of clinical and serological features of COVID-19 in urban hemodialysis patients, J Clin Med
Wang, He, Liao, Clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 and impact of proactive chest computed tomography scans, Clin Kidney J
Wiersinga, Rhodes, Cheng, Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review, JAMA
Wu, Chen, Cai, Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 Pneumonia in Wuhan, China, JAMA Int Med
Xiong, Tang, Liu, Clinical characteristics of and medical interventions for COVID-19 in hemodialysis patients in Wuhan, China, J Am Soc Nephrol
Zhang, Penninger, Li, Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target, Intensive Care Med
Zhang, Yu, Pan, ACEI/ARB use and risk of infection or severity or mortality of COVID-19: a systematic review and meta-analysis, Pharmacol Res
Zhang, Zhu, Cai, Association of inpatient use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19, Circ Res
Zhao, Meng, Kumar, Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a systemic review and meta-analysis, Int J Infect Dis
Zheng, Peng, Xu, Risk factors of critical & mortal COVID-19 cases: a systematic literature review and metaanalysis, J Infect
