The first case of COVID-19 pneumonia in a hemodialysis patient in Japan
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CASE REPORT
The first case of COVID‑19 pneumonia in a hemodialysis patient in Japan Yusuke Kuroki1 · Kazutoshi Hiyama2 · Junya Minami2 · Miyoshi Takeuchi1 · Masumi Shojima1 · Shumei Matsueda1 · Hiroshi Nagae1 · Toshiaki Nakano3 Received: 10 April 2020 / Accepted: 10 June 2020 © The Author(s) 2020
Abstract On 31 December 2019, cases of pneumonia whose cause was later identified as SARS-CoV-2 were detected in Wuhan City, Hubei Province of China, and now COVID-19 has spread worldwide. On March 1, 2020, a 69-year-old Japanese man who had been on hemodialysis for 3 years was diagnosed as having COVID-19 pneumonia and hospitalized at our Medical Center. Pulmonary CT revealed bilateral multiple consolidation with bilateral pleural effusion. Aggressive weight reduction was needed to improve the patient’s respiratory condition. Hemodialysis therapy was performed in isolation with hydroxychloroquine administration, but the formation of a dialysis membrane clot forced the withdrawal of dialysis therapy. Changing the dialysis membrane material and anticoagulant enabled the resumption of dialysis therapy, allowing the body weight to correct downward. On the 5th hospitalization day, the patient’s fever dropped and he showed improved oxygenation and chest X-ray. He was eventually discharged. The hydroxychloroquine and appropriate fluid management may have contributed to the patient’s recovery. Clinicians should pay close attention to avoid dialysis-related problems when treating a patient with COVID-19. Keywords COVID-19 · Hemodialysis · Hydroxychloroquine · Pneumonia · Fluid management · Dialysis membrane · Clot formation
Introduction On 31 December 2019, the World Health Organization (WHO) China Country Office was informed of cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan City, Hubei Province of China [1]. A novel coronavirus was later identified as the cause of this outbreak: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The WHO named the disease caused by this novel coronavirus ‘COVID-19’. On March 11, 2020, the WHO declared a pandemic based on the worldwide spread * Yusuke Kuroki [email protected]
of COVID-19. As of April 9, 2020, 212 countries, areas, and territories were confirmed to have COVID-19-infected individuals. Dialysis therapy was provided for an estimated 2.6 million people worldwide in 2010, and this number is expected to increase [2]. If COVID-19 infection continues to spread, it is highly possible that the disease will spread to patients with end-stage kidney disease (ESKD). Here, we describe our experience with a first case of COVID-19 pneumonia in a maintenance hemodialysis patient in Japan. We provide the details of our patient’s case herein, focusing on the precautions needed when performing dialysis therapy for patients with COVID-19.
Division of Nephrology, National Hospital Organization Fukuokahigashi Medical Center, Koga, Japan
Case presentation
2
Division of Infectious Disease, National Hospital Organization Fukuokahigashi Medic
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