In Brief |Immune Responses of patients on maintenance haemodialysis after infection by SARS-CoV-2: a prospective observational cohort study

Originally published In BMC Infectious Diseases: 6 September 2023

In patients with acute COVID-19 undergoing chronic haemodialysis (CHD), immune system dysfunction and inflammation are heightened, perpetuating chronic systemic inflammation. When severe respiratory failure occurs, these patients exhibit complex immune abnormalities, including both hyper-immune activation and immunoparalysis. Those with comorbidities, particularly End-Stage Renal Disease (ESRD) on CHD, are at increased risk of unfavourable outcomes. 
 

This observational prospective cohort study aimed to understand immune changes and their impact on outcomes in such patients.
 

• The primary study endpoint was the differences between cytokines and white blood cell subsets between patients on CHD who had COVID-19,  and comparators on CHD who were uninfected.

• The secondary study endpoint was to identify the best predictor of the 28-day outcome. ?Pre-defined outcomes were WHO-CPS of 6 or more (interpreted as hospitalized with severe disease or dead) at day 28 and WHO-CPS of 3 or less at day 28 (interpreted as ambulatory disease).

• Fifty-nine hospitalised patients, and 20 comparators were enrolled. The two groups were matched for age, gender, comorbidities and frailty index.

The following findings were recorded:
 

• Primary Endpoint

  • TNFα, IFNγ and PDGF-A were higher in patients than in the comparator group. The only exception was TNFα, which was higher in patients only before the start of HD. 

  • The concentrations of cytokines found in the dialysate were low, with the exceptions of IL-10 and PDGF-A.

  • Both IL-10 and PDGF-A were increased in the dialysate of COVID-19 patients.

  • The absolute counts of CD4-lymphocytes and CD19-lymphocytes were significantly lower in patients than the uninfected comparators before and after the HD session.

  • The expression of HLA-DR on CD14-monocytes of patients, provided as the MFI, was significantly lower than comparators both before and after the HD session
    
     

• Secondary Endpoints

  • When baseline demographics, circulating cytokines and cell subsets were compared between patients who at day 28 were at WHO-CPS ≥ 6 and at WHO-CPS < 6, no differences were found
    The only exception was the expression of HLA-DR on CD14-monocytes at the end of HD, which was lower among patients with WHO-CPS ≥ 6
     

  • When baseline demographics, circulating cytokines and cell subsets were compared between patients who were at WHO-CPS ≤ 3 and at WHO-CPS > 3 on day 28,  no differences were found
    The only exception of the absolute counts of CD19-lymphocytes at the end of HD, which were greater among patients with WHO-CPS ≤ 3.

These findings suggest that patients undergoing CHD develop an inflammatory reaction to SARS-CoV-2, which is characterized by the increase of inflammatory mediators, a decrease of circulating T-lymphocytes and a decrease in the expression of HLA-DR on CD14-monocytes. 

Access the original article 
 

1.Bacharaki, D., Karagiannis, M., Giannakopoulos, P. et al. Immune responses of patients on maintenance hemodialysis after infection by SARS-CoV-2: a prospective observational cohort study. BMC Infect Dis 23, 581 (2023). https://doi.org/10.1186/s12879-023-08569-2

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