PRESENTED BY
EMILIO SANCHEZ

Presentation Summary

Written by Jasna Trbojevic-Stankovic
Reviewed by Emilio Sanchez

An unprecendented outbreak of pneumonia, caused by a betacoronavirus named SARS-CoV-2, urged the World Health Organization to proclaim a pandemic of the novel coronavirus disease (COVID-19). The first cases of the disease were registered in the Chinese province of Hubei in December 2019, but it spread rapidly to the rest of the world. The first case of COVID-19 in Spain was registered on January 31st in a German tourist spending his holiday on the island of La Gomera. Two and a half months later there were 177.633 registered cases in Spain, accounting for nearly twenty percent of all cases in Europe at that moment. The sudden rise in the number of infected Spaniards started on March 8th and continued exponentially to reach the peak with over nine thousand new cases registered on March 31st. The cities with highest numbers of cases were Madrid and Cataluna. After that point, a slow, but persistent decline in the number of new cases has been observed.
On March 8th the Spanish Society of Nephrology (SSN) started an on-line gathering of data for the COVID-19 Registry of SARS-CoV-2 positive patients undergoing renal replacement therapies (RRT). All contributors needed to register at the official SSN webpage and were provided access only to the data of the patients they had registered themselves. The data required included the modality and duration of RRT, time of COVID-19 diagnosis, prior contact, disease presentation, treatment and outcome (Figure 1).

Figure 1. The Spanish Society of Nephrology COVID-19 Registry (1)

 

 

The overall number of registered RRT patients with COVID-19 by May 9th was 1.492, that were analyzed. Over half of those were located in the regions of Madrid (35.3%) and Cataluna (20%), which corresponded to the distribution of COVID-19 cases in the general population. The average age of the infected patients was 67 years, and about two-thirds of them were males. Mostly affected by COVID-19 were in-centre haemodialysis patients (63%), followed by transplanted (34%) and peritoneal dialysis patients (3%). Only four patients on home haemodialysis were reported. This distribution pattern did not correspond to the overall distribution of patients on RRT, where more than half are transplanted, and thus on constant immunosuppression. Still, these results are not surprising since haemodialysis patients are especially vulnerable to contagion due to lower immunity and the need for frequent attendance to healthcare facilities. Only 30% of registered patients, mostly those on haemodialysis, had known prior contact. The average incubation period in patients with prior contact was one week. The disease most often presented with fever and symptoms of upper respiratory infection or dyspnoea. Viral pneumonia developed in 72% of the patients, and only 8% were asymptomatic. Lymphopenia was present in near 80% of the cases (Figure 2).

Figure 2. Clinical presentation of COVID-19 in renal replacement therapy patients (1)

 

Most patients (81%) required hospital treatment, and 7% of those needed intensive care. Forty patients were put on mechanic ventilation. Hydroxychloroquine was administered to 85% of the patients, less than half (40%) were treated with lopinavir/ritonavir combination, one third with steroids, while tocilizumab and interferon were administered to 10% and 5% of the patients respectively.

Several important differences were noted between dialysed and transplanted patients with COVID-19. Transplanted patients were significantly younger, but significantly more often presented with a severe form of COVID-19 which required hospitalization and intensive care. They were more often treated with hydroxychloroquine, steroids and tocilizumab than dialysed patients. The recovery rate was significantly higher, and the mortality rate significantly lower in transplanted than in dialysed patients (Figure 3).

Figure 3. Characteristics of dialysed and transplanted patients with COVID-19 (1)

 

 

Analysis of the cases with an outcome also returned interesting results. The average time of recovery was seventeen days. Patients with lethal outcome were older, more often treated with in-center haemodialysis, developed pneumonia, and received lopinavir/ritonavir and steroid treatments. Furthermore, they were less often treated with renin-angiotensin-aldosteron system blockers than patients with favourable outcome. Age and development of pneumonia were associated with mortality in both transplanted and dialysed patients. After adjusting for age and diabetic condition, PD is associated with better survival than in-centre HD.

References

1. Sanchez E. The COVID-19 Registry – the Spanish experience. Available at: https://www.youtube.com/watch?v=Bny-yvJ0HBk&feature=youtu.be Accessed May 2, 2020.

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