Clinical Characteristics and Outcomes of Coronavirus Disease 2019 Infection of In-center Hemodialysis Patients: An Experience of a Dialysis Center from Pakistan

Much has now been learned about the coronavirus disease 2019 (COVID-19) in the general population, but data for hemodialysis (HD) patients are limited. This is the first study of COVID-19 disease in patients undergoing maintenance HD in Pakistan. We studied the epidemiological, clinical, laboratory, radiological characteristics, and outcomes of a cohort of HD patients that contracted COVID-19 in our HD center from the first confirmed case on May 12, 2020, until September 9, 2020. Out of the total 423 patients being dialyzed in our center, 87 were suspected and 50 (11.8%) were confirmed for COVID-19. Male:Female ratio was nearly equal. The median age was 59.5 +/- 9.99 years. Most patients developed mild disease. The most common symptoms were fever (82%). Ten (20%) had patchy bilateral opacity (ground-glass opacity) on the chest radiograph. Major complications were lymphocytopenia (36%), thrombocytopenia (30%), pneumonia (28%), and septic shock (6%). Eleven (22%) patients were hospitalized. Five required mechanical ventilation. Ten (20%) patients died. The relative risk of death with COVID-19 in HD patient was 1.46 with 95% confidence interval 1.15-1.84, (P = 0.003). The patients aged >= 60 years had 4.3 times more severe disease (P = 0.044) and died 3.3 times (P = 0.164) more than patients aged < 60 years. HD patients have a high susceptibility to COVID-19 compared to the general population with an increased mortality rate and prolonged recovery time. Patients with age > 60 years, female gender, diabetics, and those presented with more severe symptoms and laboratory parameters, had a higher fatal outcome.