Connerney Michael, Sattar Yasar, Rauf Hiba, Mamtani Sahil, Ullah Waqas, Michaelson Nara, Dhamrah Umaima, Lal Naman, Latchana Sharaad, Stern Aaron Saul
Internal Medicine, Icahn School of Medicine at Mount Sinai - Elmhurst Hospital, Queens, New York.
Internal Medicine, American Society of Clinical Oncology, Alexandria, VA.
Clin Nephrol Case Stud. 2021 Mar 11;9:26-32. doi: 10.5414/CNCS110240. eCollection 2021.
Increased incidence of kidney injury has been seen in patients with COVID-19. However, less is known about COVID-19 susceptibility and outcomes in end-stage renal disease (ESRD) patients on hemodialysis (HD). Reduced angiotensin-converting enzyme 2 (ACE-2) from SARS-CoV-2 binding and increased angiotensin II (Ang-II) activity have been suggested as mechanisms for COVID-19 renal pathophysiology.
In this case series, we analyzed the data of 3 patients with ESRD who had a delay in receiving their regular HD. Reduced oxygen requirement, resolved hyperkalemia, and normalized fluid status were used for the basis of discharge.
Presenting symptoms included fever, dyspnea, and dry cough. Laboratory markers were characteristic for COVID-19, such as lymphopenia, elevated D-dimer, C-reactive protein (CRP), and interleukin 6 (IL-6). All 3 of our reported patients required urgent HD upon admission. However, we report no fatalities in our case series, and our patients did not have a severe course of illness requiring endotracheal intubation. We reviewed COVID-19 pathophysiology and how patients with ESRD on HD may be particularly at risk for infection.
New renal failure or ESRD sequelae, such as hyperkalemia, uremic encephalopathy, and fluid overload, can be exacerbated by a delay in receiving HD due to COVID-19 infection. Both direct COVID-19 infection and the challenges this pandemic creates to health care logistics present unique threats to ESRD patients on HD.
新型冠状病毒肺炎（COVID-19）患者中肾损伤的发生率有所增加。然而，对于接受血液透析（HD）的终末期肾病（ESRD）患者的COVID-19易感性和预后了解较少。有人提出，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）结合导致血管紧张素转换酶2（ACE-2）减少以及血管紧张素II（Ang-II）活性增加是COVID-19肾脏病理生理学的机制。
在这个病例系列中，我们分析了3例接受常规HD延迟的ESRD患者的数据。出院依据为氧需求降低、高钾血症缓解和液体状态正常化。
呈现的症状包括发热、呼吸困难和干咳。实验室指标具有COVID-19的特征，如淋巴细胞减少、D-二聚体、C反应蛋白（CRP）和白细胞介素6（IL-6）升高。我们报告的所有3例患者入院时都需要紧急HD。然而，我们的病例系列中没有死亡病例，并且我们的患者没有出现需要气管插管的严重病程。我们回顾了COVID-19的病理生理学以及HD的ESRD患者如何特别容易感染。
由于COVID-19感染导致HD延迟，可能会加剧新的肾衰竭或ESRD后遗症，如高钾血症、尿毒症性脑病和液体超负荷。COVID-19的直接感染以及这场大流行给医疗后勤带来的挑战，对HD的ESRD患者构成了独特的威胁。
