A case of novel coronavirus disease 19 in a chronic hemodialysis patient with severe cardiovascular disease

Introduction: Patients on maintenance hemodialysis (MHD) are vulnerable to COVID-19 MHD individuals are usually old with chronic comorbidities while these features are all risk factors of poor prognosis Case Description: Our patient was a 79-year-old female with ESRD and had been on MHD for 12 years in Wuhan She had a history of severe coronary heart disease The patient firstly reported fever, chest tightness and cough One week later, she developed diarrhea and the chest CT indicated “viral pneumonia” Her COVID-19 testing was reported positive, and she was admitted to the hospital with SpO2 of 92% and high level of hs-CRP, cardiac troponin I (TNI) and creatine kinase MB isoenzyme She was prescribed oxygen therapy, methylprednisolone, intravenous immunoglobulin, prophylactic anticoagulation and CRRT therapy Her respiratory condition improved gradually and COVID-19 testing showed negative However, on admission day 19, the patient presented psychiatric symptom, and was considered as secondary higher-level cognitive impairment since she received regular CRRT therapy without using drugs which could cause mental disorders Two days later, her chest X-ray showed lung infection advanced with increased hs-CRP and PCT indicating bacterial infection We prescribed meropenem and vancomycin Meanwhile, there was an increasing trend of TNI, and electrocardiogram indicated acute coronary syndrome (ACS) Clopidogrel, aspirin and atorvastatin were prescribed immediately Unfortunately, on admission day 22, the patient suffered cardiac arrest and was declared dead after active rescue The cause of death was considered as cardiogenic shock and ACS Discussion: To our experience, personalized immunomodulation therapies against “cytokine storm” including steroid, intravenous immunoglobulin and CRRT might playimportant role in treating severe COVID-19 patients with MHD Cardiovascular disease is the leading cause of death in ESRD patients The cardiovascular events of this patient might be combined with COVID-19 associated heart injury and worsen of pre-existing CHD We suggested lack of family support during quarantine might be a reason of psychiatric symptom In conclusion, personalized immunomodulation therapies might be helpful in treating severe COVID-19 patients with MHD Cardiovascular events were associated with poor outcome