Severe acute respiratory SARS-CoV-2 infection in dialysis patients in northern Italy: a single-centre experience

Fontana, Francesco; Giaroni, Francesco; Frisina, Monica; Alfano, Gaetano; Mori, Giacomo; Lucchi, Leonardo; Magistroni, Riccardo; Cappelli, Gianni

BACKGROUND: Dialysis patients are considered at high risk for COVID-19 and the infection can easily spread in dialysis units. METHODS: We conducted an observational single-centre cohort study to describe clinical characteristics, treatments and outcomes of dialysis patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We tested patients who presented symptoms or had contact with a confirmed case. We enrolled 15 patients positive for SARS-CoV-2. RESULTS: We tested 37 of 306 dialysis patients. Patients with SARS-CoV-2 infection were older (mean age 75.96 ± 11.09 years) and all had comorbidities. At presentation, most had interstitial infiltrates on chest X-ray, three-quarters had leucopenia and none had respiratory insufficiency. During follow-up, there was an increase in serum C-reactive protein and interleukin-6. Eighty percent of patients received supplemental oxygen; none received non-invasive ventilation, one was intubated. Most patients (80%) were treated with oral hydroxychloroquine for a median time of 6.5 days [interquartile range (IQR) 5–14.5] and 40% received azithromycin; two patients received a short course of antivirals and one received a single dose of tocilizumab. Only two patients did not require hospitalization. Of the nine survivors, eight still tested positive for SARS-CoV-2 a median of 19 days (IQR 9.25–23) after diagnosis. Six patients died (case fatality rate 40%) a median of 5.5 days (IQR 1.75–9.75) after diagnosis. The main reported cause of death was respiratory failure related to COVID-19 (five patients). CONCLUSIONS: We report a single-centre experience of SARS-CoV-2 infection in dialysis patients. The disease showed a high case fatality rate and most patients required hospitalization. Survivors show prolonged viral shedding.