COVID-19 in Patients Undergoing Hemodialysis: Prevalence and Asymptomatic Screening During a Period of High Community Prevalence in a Large Paris Center

Abstract Rationale & Objective Due to extensive comorbid conditions, COVID-19 has a poor prognosis in people receiving maintenance hemodialysis. In this paper, we describe our experience with 200 maintenance hemodialysis patients in a hemodialysis center that employed universal RT-PCR testing, including 38 COVID-positive patients. Study Design Descriptive observational cohort, including the timeline of patient diagnoses along with contextual events including precautions, testing, screening algorithms, clinical diagnostics and therapy, as well as the clinical course of the COVID infected patients and their final outcomes. Setting & Participants 200 patients within a single hemodialysis center with two dialysis clinics in Paris. Results Among 200 maintenance hemodialysis patients, 38 (19%) were diagnosed with COVID-19; of these, 15 (39.5%) were admitted to the hospital including four who required intensive care unit (ICU) care. There were 8 deaths (21%). The most common symptom was fever, followed by dry cough, fatigue and dyspnea. All COVID-19 patients had lymphopenia and an increase of C-reactive protein. The median time from the onset of respiratory symptoms to ICU admission was one to two days. The duration of non-ICU hospitalization and of ICU stays was 7 and 13 days, respectively. Limitations Retrospective study, single HD center Conclusions Dialysis patients are a highly susceptible population and hemodialysis centers are a high-risk area in a COVID-19 epidemic. "Unexplained" lymphopenia and/or a rise in C-reactive protein should lead physicians to the diagnosis of COVID-19, and should, when possible, be followed by diagnostic testing with universal RT-PCR as well as the reinforcement of contamination barrier measures.