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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 267-272. doi: 10.19723/j.issn.1671-167X.2024.02.010

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Clinical characteristics of COVID-19 infection in patients undergoing hemodialysis

Jinrong ZHU,Yana ZHAO,Wei HUANG,Weiwei ZHAO,Yue WANG,Song WANG,Chunyan SU*()   

  1. Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-05-16 Online:2024-04-18 Published:2024-04-10
  • Contact: Chunyan SU E-mail:scybmu@126.com

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Abstract:

Objective: To analyze the clinical characteristics of hemodialysis patients with corona virus disease 2019 (COVID-19) in a single-center from Beijing. Methods: Patients with COVID-19 who received regular hemodialysis at Peking University Third Hospital from November 30, 2022 to January 4, 2023 were selected as the study objects. Clinical symptoms, severity and duration of symptoms during the period of virus positive were investigated in the form of questionnaires, and the basic information of the patients, as well as the results of blood tests (routine blood and blood biochemistry, etc.) before and after infection, dialysis treatment and the outcome of the disease were collected by consulting medical records. Results: A total of 203 subjects were included in this study, including 148 mild cases (72.91%), 23 medium cases (11.33%), 32 severe and critical cases (15.76%), and 16 (7.88%) deaths occured during the follow-up. Clinical symptoms mainly included respiratory symptoms (among which 81.77% had cough, 68.97% had expectoration), fever (81.28%) and fatigue (65.52%), and fatigue and weakness had the longest duration [9 (5, 15) days] among all symptoms. Twenty-six patients (12.8%) reduced the dialysis sessions [1 (1, 2) times], 25 patients (12.32%) had the behavior of early finishing dialysis (27 times), reducing the dialysis time by 30.0 (20.0, 30.5) minutes. Univa-riate analysis showed that the hemoglobin, creatinine, urea nitrogen and ultrafiltration decreased signi-ficantly after infection (P < 0.05). There were significant differences in age, albumin, hemoglobin, creatinine levels and vascular access types among the patients with different clinical subtypes, and the changes of dialysis sessions, fever, expectoration and fatigue degree were also different among the patients with different clinical subtypes (P < 0.05). Multivariate Logistic regression analysis showed that age (OR=1.051, 95%CI: 1.017-1.086, P=0.003) and albumin levels (OR=0.905, 95%CI: 0.803-1.019, P=0.098) corrected by fever, expectoration and fatigue levels were still associated with the occurrence of pneumonia. Conclusion: The morbidity of pneumonia and the proportion of deaths in hemodialysis patients with COVID-19 were higher, and some clinical symptoms lasted for a longer time than the general population. During the infection period, the incidence of dialysis-related complications increased, hemoglobin and nutritional status decreased. Elderly patients and patients with low albumin level had a higher risk of developing pneumonia after infection.

Key words: Hemodialysis, COVID-19, Pneumonia, Risk factors

CLC Number: 

  • R459.52

Table 1

Frequency and duration of clinical symptoms in hemodialysis patients infected with COVID-19 (n=194)"

Symptom n(%) Lasting days, M(P25, P75) Symptom n(%) Lasting days, M(P25, P75)
Cough 166 (81.77) 7.00 (3.00, 12.00) Hypogeusia 77 (37.93) 7.00 (4.00, 14.00)
Fever 165 (81.28) 2.00 (1.00, 3.00) Loss of appetite 67 (33.00) 7.00 (3.00, 12.00)
Expectoration 140 (68.97) 7.00 (3.00, 12.00) Nausea and vomiting 64 (31.53) 3.00 (1.00, 6.25)
Fatigue 133 (65.52) 9.00 (5.00, 15.00) Diarrhea 59 (29.06) 3.00 (2.00, 5.00)
Muscular soreness 105 (51.72) 5.00 (3.00, 7.00) Hyposmia 58 (28.57) 7.00 (3.00, 12.00)
Throat pain 89 (43.83) 5.00 (3.00, 7.00) Conjunctivitis 18 (8.87) 4.00 (3.00, 10.00)
Nasal congestion and runny nose 81 (39.90) 6.00 (3.00, 8.00) Hearing loss 3 (1.48) 8.50 (1.75, 13.75)

Table 2

Changes of laboratory tests and ultrafiltration volume before and after infection (n=194)"

Variable Pre-infection Post-infection t P
Hemoglobin/(g/L) 113.71±12.35 102.38±13.29 8.562 ＜0.001
Creatinine/(μmol/L) 1 012.24±264.22 976.52±290.59 3.209 0.002
Urea nitrogen/(mmol/L) 26.45±5.87 25.49±6.56 2.068 0.040
Ultrafiltration/L 2.65±0.94 2.10±0.88 8.880 ＜0.001

Table 3

Comparison of pre-infection clinical data and post-infection clinical manifestations of patients with different clinical types (n=203)"

Items Mild type(n=148) Medium type(n=23) Severe and critical type (n=32) χ2/F/Z P
Pre-infection clinical data
  Age 59.00±13.05 60.04±12.96 73.66±9.87 17.962 ＜0.001
  Albumin/(g/L) 38.08±3.22 37.44±2.99 34.96±4.01 11.253 ＜0.001
  Hemoglobin/(g/L) 114.83±12.69 107.39±14.01 113.31±10.38 3.540 0.031
  Creatinine/(μmol/L) 1 025.80±266.36 1 031.13±332.01 793.38±251.05 9.074 ＜0.001
  Vascular access 10.745 0.016
    Arteriovenous fistula 133 (89.86) 17 (73.91) 23 (71.88)
    Graft fistula 5 (3.38) 3 (13.04) 4 (12.50)
    Central venous catheter 10 (6.76) 3 (13.04) 5 (15.63)
Post-infection clinical data
  Variation of dialysis frequency -0.10±0.48 -0.52±1.38 0.00±1.00 3.919 0.021
  Cases of early termination of dialysis 12 (8.11) 7 (30.43) 6 (18.75) 9.056 0.011
  Degree of fever 18.391 0.010
    None 19 (12.84) 1 (4.35) 1 (4.35)
    Slight 46 (31.08) 4 (17.39) 4 (17.39)
    Moderate 55 (37.16) 7 (30.43) 8 (34.78)
    Relatively serious 25 (16.89) 10 (43.48) 6 (26.09)
    Very serious 3 (2.03) 1 (4.35) 4 (17.39)
  Degree of expectoration 23.176 0.001
    None 42 (28.38) 4 (17.39) 1 (4.35)
    Slight 60 (40.54) 4 (17.39) 12 (52.17)
    Moderate 33 (22.30) 9 (39.13) 4 (17.39)
    Relatively serious 10 (6.76) 5 (27.78) 3 (13.04)
    Very serious 3 (2.03) 1 (4.35) 3 (13.04)
  Degree of fatigue 27.786 ＜0.001
    None 37 (25.00) 6 (26.09) 2 (8.70)
    Slight 38 (25.68) 0 2 (8.70)
    Moderate 44 (29.73) 6 (26.09) 7 (30.43)
    Relatively serious 23 (15.54) 7 (30.43) 6 (26.09)
    Very serious 6 (4.05) 4 (17.39) 6 (26.09)

Table 4

Variable assignment table"

Variable Assignment value
Vascular access Arteriovenous fistula: z1=0, z2=0, z3=0;
Graft fistula: z1=0, z2=1, z3=0;
Central venous catheter: z1=0, z2=0, z3=1
Degree of fever 0=none; 1=slight; 2=moderate; 3=relatively serious; 4=very serious
Degree of expectoration 0=none; 1=slight; 2=moderate; 3=relatively serious; 4=very serious
Degree of fatigue 0=none; 1=slight; 2=moderate; 3=relatively serious; 4=very serious
Whether pneumonia occured 1=yes; 0=no

Table 5

Multivariate Logistic regression analysis of pneumonia caused by COVID-19 infection in hemodialysis patients(n=203)"

Items β SE Wald value OR (95%CI) P value
Constant -2.714 2.761 8.985 0.066 0.326
Age 0.050 0.017 2.738 1.051 (1.017-1.086) 0.003
Albumin -0.100 0.061 10.604 0.905 (0.803-1.019) 0.098
Degree of fever 0.686 0.211 6.812 1.985 (1.314-3.000) 0.001
Degree of fatigue 0.424 0.162 0.967 1.528 (1.111-2.100) 0.009
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