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Abstract: PO0736

Non-Hospitalized Maintenance Hemodialysis Patients with COVID-19 Have Elevated Inflammatory Markers

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Hegde, Akhil, UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Flythe, Jennifer E., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Denu-Ciocca, Cynthia J., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Swain, Kawan A., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Voora, Raven A., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Ansede, Heather J., Renal Research Institute, New York, New York, United States
  • Hladik, Gerald A., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Roy-Chaudhury, Prabir, UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Kshirsagar, Abhijit V., UNC Kidney Center, Chapel Hill, North Carolina, United States
Background

In addition to an aggressive pneumonia, patients hospitalized with COVID-19 have marked inflammatory and hypercoagulable states, with downstream cardiovascular and thrombotic events. Hemodialysis patients have baseline increases in inflammation and hypercoagulability. However, to our knowledge, little is known about the level of inflammation and hypercoagulability among non-hospitalized in-center hemodialysis patients with COVID-19. We collected inflammatory and coagulation markers among hemodialysis patients with COVID-19 who were managed as outpatients.

Methods

Patients in our dialysis program with one positive nasopharyngeal swab PCR for SARS-CoV-2 were consecutively admitted to an outpatient COVID-19 hemodialysis shift. While receiving their usual dialysis prescription, the patients also had weekly measurements of D-Dimer, Fibrinogen, C-reactive protein (CRP), and Serum Ferritin, until they tested negative x 2 for SARS-CoV-2.

Results

16 consecutive patients were admitted to the COVID-19 isolation shift over 30 days. Their average age was 60 yr, 56% were Black, 25% Hispanic, and 44% female. Causes of ESKD included diabetes (75%), glomerular diseases (19%), and hypertension (6%). No patients received intravenous iron supplementation while on the isolation shift. Table 1 displays the inflammatory marker levels in this group. Note, the 4-fold (D-Dimer), 6-fold (Ferritin) and 21-fold (CRP) increase in these biomarkers from normal levels.

Conclusion

Our initial, unique data show an increase in inflammatory markers in a cohort of non-hospitalized COVID-19 hemodialysis patients. Such an increase may be from the pro-inflammatory impact of COVID-19 in a group with pre-existing high levels of inflammation from uremia and oxidative stress. Additional investigation as to whether these elevated markers associate with cardiovascular and thrombotic events (dialysis circuit and vascular access clotting, sudden cardiac death) is needed.

Inflammatory Markers among Non-Hospitalized HD Patients with COVID-19
 Mean ± S.D.Observed RangeNormal Range(non-ESKD)
D-Dimer mcg/mL2.0±1.00.4 - >4.00.0-0.5
Fibrinogen mg/dL527.4±122.7273-960217-480
C-reactive protein mg/L50.4±54.40.9-4770.0-2.4
Serum Ferritin ng/mL1954.6±1697.0419-1106622-322

Funding

  • NIDDK Support