key: cord-318029-xd7nuahh authors: Ke, Chunjin; Wang, Yufeng; Zeng, Xing; Yang, Chunguang; Hu, Zhiquan title: 2019 novel coronavirus disease (COVID-19) in hemodialysis patients: a report of two cases date: 2020-04-30 journal: Clin Biochem DOI: 10.1016/j.clinbiochem.2020.04.008 sha: doc_id: 318029 cord_uid: xd7nuahh OBJECTIVE: To analyze the diagnosis and treatment of patients with chronic renal failure complicated with novel coronavirus pneumonia, and to evaluate the effect of blood purification technology on the treatment and prognosis of such patients METHODS: Two COVID-19 cases undergoing hemodialysis with chronic renal failure were retrospectively analysed in our hospital. RESULTS: Two COVID-19 patients were admitted to hospital due to cough, with or without fever. Laboratory tests showed decreased lymphocyte count, elevated PCT, IL-10, IL-6, TNF-α, IL-2R, high-sensitivity cardiac troponin I, NT-proBNP, creatinine, and urea nitrogen. Chest CT scan showed multiple blurred plaques and patchy shadows in both patients. Two patients received continuous venovenous hemodiafiltration (CVVHDF) every other day for 4-6 hours everytime, in addition to the standard treatment. After CVVHDF, not only cytokines were reduced, but also liver function and cardiac function significantly improved. Both patients did not develop severe pneumonia. They were discharged on March 1, 2020 when meeting the discharge criteria. CONCLUSION: Two COVID-19 patients on maintenance hemodialysis discharged after a month of hospitalization. The removal of cytokines through blood purification technology may be beneficial for the recovery of COVID-19 patients. Since December 2019, multiple cases of unexplained viral pneumonia have been detected in Wuhan, Hubei Province [1, 2] . On January 8, 2020, the Chinese Center for Disease Control and Prevention officially announced the pneumonia was caused by a new type of coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [2] . As of March 3, 2020, SARS-CoV-2 has infected a total of 80,422 people in China, with a mortality rate of 3.71%. More than 12,000 people were University of Science and Technology were retrospectively analysed. Case 1, male, 79 years old, was admitted to the community hospital on January 25, 2020 because of "fever and cough for 2 days". After receiving antibiotic, he felt no relief and came to our hospital for further treatment. Note: CVVHDF, continuous venovenous hemodiafiltration; PCT, procalcitonin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; NT-proBNP, Amino terminal brain natriuretic peptide precursor; IL, Interleukin; TNF-α,Tumor necrosis factor-α SARS-CoV-2 is an enveloped, single-stranded RNA beta coronavirus [3] [4] [5] . COVID-19 is not only harmful to respiratory system characterized by viral pneumonia, but also combined with damage to kidney, heart, blood, nervous system and other organs. Hyperviremia and cytokine storm are important causes for COVID-19's evolution to severe pneumonia, even to multiple organ dysfunction in a few cases [6] . In addition, comorbidities such as diabetes, heart failure and acute renal failure indicate poor prognosis 6 . According to the research on SARS-CoV and MERS-CoV, human coronavirus can replicate to a high titer at early stage. This high replication may lead to enhanced cytopathic effects and higher levels of pro-inflammatory cytokines produced by infected epithelial cells. These cytokines, in turn, induce large numbers of inflammatory cells penetrating into the lung [7] [8] [9] [10] . Disrupting the antiviral response by antagonizing IFN can achieve innate immune delay or immune evasion [10] [11] [12] [13] [14] . Excessive release of inflammatory cytokines and the formation of a series of self-amplifying cytokines activate a cascade of reactions, causing damage to diffuse alveolar, transparent membranes formation and fibrotic protein exudation. In severe cases, cytokine storm can induce hemodynamic instability, DIC, and multiple organ dysfunction. Increased levels of IL-6, IL-10, TNF-α and other inflammatory cytokines in COVID-19 patients are related to poor prognosis [15] . This is consistent with the phenomenon that two cases suffered from multiple organ dysfunction, with serum cytokines significantly increased. To date, there are currently no effective antiviral drugs against SARS-CoV-2. 8 Although glucocorticoids can inhibit the excessive activation of inflammatory factors, large doses of glucocorticoids will delay the elimination of new coronavirus due to immunosuppressive effects [16] . CT showed a sensitivity of 97% for COVID-19 [19] . Chest CT has a high diagnostic sensitivity for COVID-19, which can be used as the main tool for COVID-19 detection in epidemic areas. Chest CT scan of these two cases showed multiple blurred plaques and patchy shadows in both lungs, similar with COVID-19 patients without chronic renal failure. In summary, two COVID-19 patients on maintenance hemodialysis were cured after a month of hospitalization. Blood purification technology seems to be helpful for preventing COVID-19 patients with chronic renal failure from severe pneumonia or even multiple organ dysfunction. Chunjin Ke: Writing -Conceptualization; original draft. Yufeng Wang: Data curation; Formal analysis. Xing Zeng: Software; Supervision. Chunguang Yang: Funding acquisition; Writing -review & editing. Zhiquan Hu: Project administration; Resources. 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The authors declare no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Lifespan institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.