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.