Clinical characteristics, management, and outcomes in COVID-19-positive dialysis patients from three London Renal Centres, United Kingdom

Background: Dialysis patients, with frequent co-morbidities, advanced age and frailty, visiting treatment facilities frequently are perhaps more prone to SARS-Cov-2 infection and related death - the risk-factors and dynamics of which are unknown The aim of this study was to investigate the hospital outcomes in SARS-CoV-2 infected dialysis patients Methods: This prospective, observational, multi-centre study collected data on SARS-CoV-2 infected HD patients between 29/02/2020 and 15/05/2020 Data was collected on demographics, comorbidities, WHO performance status, clinical symptoms, laboratory parameters, hospital management and outcomes Treatment was predominantly supportive, unless patients were part of an approved clinical trial The study was approved by NHS Research Ethics Committee 20/SW/0077 and Heath Research Authority IRAS 283130 Results: Of 1737 HD patients at the 3 renal centres, 224 (13%) were COVID-19 positive over the study period The characteristics of the COVID-19 HD patients were: mean age 65 8;59% male;38% Caucasian;81% hypertension;54% diabetes;25% chronic lung disease;29% ischaemic heart disease and 22% cerebrovascular disease The most common symptoms at presentation were fever (62%) and cough (53%) About 143 (64%) patients were managed as an inpatient and 81 (36%) as an outpatient Of 9 patients that required mechanical ventilation: 6 died, 1 patient was discharged and 2 are still under clinical care Overall 51 patients died (23%), 154 (69%) were discharged alive and 19 (8%) were still under clinical care as of 15/05/2020 Preliminary analyses suggested that those that died were significantly older (p=0 0028), more likely to have ischaemic heart disease (p=0 003), cerebrovascular disease (p=0 019), smoking history (p=0 006), WHO performance status 3-4 (p=0 004), higher neutrophil: lymphocyte ratio at presentation (p=0 0001) and higher CRP at presentation (p=0 0021) Conclusions: This large cohort of COVID-19 positive haemodialysis demonstrates a high case fatality ratio, which increased significantly with age, cardiovascular disease, smoking history, frailty and markers of inflammation