COVID-19 in grade 4-5 chronic kidney disease patients

Collado Nieto, Silvia; Arenas Jiménez, María Dolores; Barbosa Puig, Francisco; Cao Baduell, Higinio; Montero, Maria Milagro; Villar García, Judit; Barrios Barrera, Clara; Rodríguez García, Eva; Sans Atxer, Laia; Sierra Ochoa, Adriana; Pérez-Sáez, María José; Redondo Pachón, María Dolores; Coca, Armando; Maiques Llácer, José María; Güerri Fernández, Roberto; Horcajada Gallego, Juan Pablo; Crespo Barrio, Marta; Pascual Santos, Julio

doi:http://dx.doi.org/10.1159/000511082

COVID-19 in grade 4-5 chronic kidney disease patients

Citation

Collado S, Arenas MD, Barbosa F, Cao H, Montero MM, Villar-García J, et al. COVID-19 in grade 4-5 chronic kidney disease patients. Kidney Blood Press Res. 2020; 45(5): 768-74. DOI: 10.1159/000511082

Abstract

Introduction: Chronic kidney disease (CKD) increases the risk of mortality during coronavirus disease 2019 (COVID-19) episodes, and some reports have underlined the high incidence and severity of this infection in dialysis patients. Information on COVID-19 in nondialysis CKD patients is not available yet. Case reports: Here we present 7 patients with grade 4-5 CKD who developed symptomatic COVID-19; they comprise 2.6% of our 267 advanced CKD patients. The estimated GFR was between 12 and 20 mL/min during the month prior to COVID-19. The 3 major symptoms were fever, cough, and dyspnea, and 5 patients showed bilateral pneumonia. Hydroxychloroquine, azithromycin, ceftriaxone, and steroids were the most frequently prescribed drugs. Two patients needed noninvasive mechanical ventilation. All patients showed minimal to moderate kidney function deterioration during admission, with an eGFR decline below 5 mL/min in 6 cases. No patient required acute dialysis. Six patients were discharged alive and remained dialysis free athe t the time of reporting, and one 76-year-old patient died. Conclusions: COVID-19 affects grade 4-5 CKD patients, but prognosis may be acceptable if prompt supportive measures are applied. These findings should be confirmed in larger cohorts, and further observations will be needed to understand the full spectrum of clinical features and the optimal approach to COVID-19 in patients with advanced CKD.