COVID-19 in Moscow patients on peritoneal dialysis: clinical phenotypes

BACKGROUND: The COVID-19 pandemic has greatly altered the management of patients with chronic conditions, including those receiving renal replacement therapy (hemodialysis and peritoneal dialysis) for end-stage renal disease.

AIM: This study aimed to identify the clinical phenotypes of patients with peritoneal dialysis and COVID-19, determine the risk factors for adverse outcomes (including death), and evaluate their impact on the progression of end-stage renal disease.

METHODS: The work presents a retrospective analysis of the clinical data of patients on peritoneal dialysis diagnosed with COVID-19 and hospitalized at Moscow City Clinical Hospital No. 52 between March 2020 and July 2023. The most frequently observed factors in adverse and fatal cases were assessed. Agglomerative clustering identified three distinct phenotypes in patients with COVID-19 and peritoneal dialysis, which differed in clinical characteristics and associated outcomes.

RESULTS: A total of 149 patients undergoing peritoneal dialysis for end-stage renal disease were hospitalized with a diagnosis of COVID-19. Of those, 38 deaths (25.5%) were reported. Deaths were associated with longer durations of renal replacement therapy, higher levels of C-reactive protein, lactate dehydrogenase, and procalcitonin, lower potassium levels at admission, and lower lymphocyte levels during hospitalization. Agglomerative clustering identified three phenotypes in patients with different outcomes. The mortality rate was 2.6% in patients with phenotype 1, 32.4% in patients with phenotype 2, and 64.1% in patients with phenotype 3. Patients with phenotype 3 (the least favorable) were older and had a higher comorbidity index. They had also received renal replacement therapy for a longer period and initially suffered from severe COVID-19 pneumonia. Patients with phenotypes 1 and 2 did not differ in terms of age or comorbidities. However, patients with phenotype 2 had more severe baseline lung lesions, as determined by computed tomography, and higher levels of systemic inflammation markers (C-reactive protein, lactate dehydrogenase, procalcitonin, and ferritin).

CONCLUSION: By predicting the progression of the COVID-19 in patients on peritoneal dialysis, we can distinguish three phenotypes characterized by differences in treatment duration, levels of inflammation markers (C-reactive protein and lactate dehydrogenase), and severity of pneumonia. These findings support the need for early risk stratification and multicenter studies to optimize clinical decisions.