2.6 COVID-19 infection and end-stage renal disease
Information on COVID-19 in end-stage renal disease (ESRD) is limited but
rapidly evolving. ESRD patients have a higher chance of contracting
COVID-19 due to suppression of the immune system, which is associated
with ESRD (Fu et al., 2020; Kunutsor and Laukkanen, 2020). While there
is no evidence-based solution to this concern, patients who are at high
risk of progressing to ESRD without immediate treatment are being
advised to postpone treatment until their local transmission rates of
COVID-19 are low. Further evidence of the impact of COVID-19 on ESRD
patients was reported where a higher rate of in-hospital death of
COVID-19 patients with ESRD compared to those without ESRD in a
retrospective study in the United States (Ng et al., 2020b). This
observation was in agreement with that of an independent study, where
the researchers evaluated clinical characteristics, laboratory measures
and clinical outcomes in 759 hospitalized COVID-19 patients out of which
45 had ESRD (Kamel et al., 2021). The authors reported that COVID-19
patients with ESRD had significantly increased leucocyte count,
C-reactive protein, lactate dehydrogenase and ferritin, and markedly
reduced serum albumin and thrombocytopenia with a higher in-hospital
mortality (18%) compared to their counterparts without ESRD (10%)
(Kamel et al., 2021). Another study also reported that COVID-19-positive
patients who had ESRD and on dialysis had better outcomes than ESRD
patients who were not on dialysis (Naaraayan et al., 2020). They
attributed their observation to a possible “pre-conditioning”, where
underlying chronic inflammation in ESRD patients on dialysis attenuates
the inflammatory response from the COVID-19 infection. It is important
to note that the spread of COVID-19 in some dialysis centers is on the
rise (e.g. Italy), which is partly due to the difficulty in applying
social distancing protocols (La Milla et al., 2020) while it is lower in
other centers (e.g. Abu Dhabi, United Arab Emirates) due to rapid
isolation of COVID-19 patients within their dialysis centers (Ahmed et
al., 2021). Taken together, COVID-19 worsens kidney condition of ESRD
patients, and thus leads to increased mortality.