Bacharaki Dimitra, Chrysanthopoulou Evangelia, Grigoropoulou Sotiria, Giannakopoulos Panagiotis, Simitsis Panagiotis, Frantzeskaki Frantzeska, Flevari Aikaterini, Karagiannis Minas, Sardeli Aggeliki, Kavatha Dimitra, Antoniadou Anastasia, Vlahakos Demetrios
Department of Nephrology, B Propaideutiki Internal Medicine Clinic, Attikon University Hospital, Chaidari 12064, Greece.
Intensive Care Unit, Attikon University Hospital, Chaidari 12064, Greece.
World J Nephrol. 2021 Mar 25;10(2):21-28. doi: 10.5527/wjn.v10.i2.21.
Coronavirus disease 2019 (COVID-19) is a highly contagious infection caused by the severe acute respiratory syndrome coronavirus 2 virus and has a unique underlying pathogenesis. Hemodialysis (HD) patients experience high risk of contamination with COVID-19 and are considered to have higher mortality rates than the general population by most but not all clinical series. We aim to highlight the peculiarities in the immune state of HD patients, who seem to have both immune-activation and immune-depression affecting their outcome in COVID-19 infection.
We report the opposite clinical outcomes (nearly asymptomatic course death) of two diabetic elderly patients infected simultaneously by COVID-19, one being on chronic HD and the other with normal renal function. They were both admitted in our hospital with COVID-19 symptoms and received the same treatment by protocol. The non-HD sibling deteriorated rapidly and was intubated and transferred to the Intensive Care Unit, where he died despite all supportive care. The HD sibling, although considered more "high-risk" for adverse outcome, followed a benign course and left the hospital alive and well.
These cases may shed light on aspects of the immune responses to COVID-19 between HD and non-HD patients and stimulate further research in pathophysiology and treatment of this dreadful disease.
2019冠状病毒病（COVID-19）是由严重急性呼吸综合征冠状病毒2引起的一种高度传染性感染，具有独特的潜在发病机制。血液透析（HD）患者感染COVID-19的风险很高，大多数但并非所有临床系列研究都认为他们的死亡率高于普通人群。我们旨在强调HD患者免疫状态的特殊性，他们似乎同时存在免疫激活和免疫抑制，这影响了他们在COVID-19感染中的预后。
我们报告了两名同时感染COVID-19的老年糖尿病患者相反的临床结局（几乎无症状病程 死亡），其中一名接受慢性血液透析，另一名肾功能正常。他们均因COVID-19症状入住我院，并按照方案接受相同治疗。未接受血液透析的患者病情迅速恶化，插管后转入重症监护病房，尽管接受了所有支持治疗仍死亡。接受血液透析的患者虽然被认为出现不良结局的“风险更高”，但病程良性，康复出院。
这些病例可能有助于揭示血液透析患者和非血液透析患者对COVID-19免疫反应的相关情况，并推动对这种可怕疾病的病理生理学和治疗方法的进一步研究。
