key: cord-0982721-3vshf6uu
authors: Delafosse, Marion; Saint-Jaques, Camille; Petit-Hoang, Camille; François, Hélène; Peltier, Julie; Nicolet, Laurence; Verney, Charles; Viguier, Martin; Letavernier, Emmanuel; Dahan, Karine
title: Steroids: a therapeutic option for COVID-19 pneumonia patients with end-stage renal disease?
date: 2020-06-17
journal: Kidney Int Rep
DOI: 10.1016/j.ekir.2020.05.031
sha: 96390bb710d3fede75184b56b07650ddce89ef53
doc_id: 982721
cord_uid: 3vshf6uu

nan

Alberici et al proposed in a recent review some therapeutic approaches for patients with end-stage renal disease (ESRD) and infected with COVID-19 (1) . They notably suggest the use of steroids during the inflammatory phase of the disease, even if their efficacy is currently being debated (2,3).

We report the outcome of 9 patients with ESRD (seven of which undergoing chronic hemodialysis), admitted in our hospital for a rapidly worsening COVID-19 pneumonia (clinical characteristics are available in Table S1 ). A short steroids therapy (Hydrocortisone hemisuccinate 200mg/day for 5 days) was administrated when the oxygen flow was increased up to 3L/min to maintain a pulse oximetry ≥ 95%. A moderate dose of steroids has been chosen to limit side effects, in particular infections. Clinical settings rapidly improved in eight patients, with a significant drop in oxygen flow within 24h (median oxygen flow: 5L/min at steroids initiation down to 3.3L/min at day 1, p = 0.034*) [ Figure 1 ]. To date, oxygen was discontinued in 7 patients (median delay after steroids initiation: 4.5 days). The latter patient, a 30 years-old-woman with severe obesity and chronic hemodialysis, needed invasive ventilation 24 hours after steroids initiation. The outcome was finally favourable and the patient was extubated 18 days after her admission to intensive unit care.

These are only the results of a small observational study and no definitive conclusion can be drawn from this report, but the quick improvement suggests that short steroids therapy could be a safe therapeutic option, especially in hemodialysis patients, who have a high risk of severe presentation (4). 

Management Of Patients On Dialysis And With Kidney Transplant During SARS-COV-2 (COVID-19) Pandemic In Brescia

On the use of corticosteroids for 2019-nCoV pneumonia

Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury

between the symptoms outbreak and the initiation of corticotherapy (days) Oxygen flow (L/min) Respiratory rate (/min) Pulse oximetry (%) CRP (mg/dL) Lymphocytes

Clinical characteristics of patients at admission and at the beginning of corticotherapy Data are expressed as median and interquartile range or absolute value and percentage

27.5 (24.9 -33.6) Men 4 (44%) ComorbiditiesHypertension Diabetes 9 (100%) 6 (67%)

Delay between the symptoms outbreak and hospitalisation (days) Oxygen flow (L/min) Respiratory rate (/min) Pulse oximetry (%) CRP (mg/dL) Lymphocytes (/mm 3 )