Impact of hemodialysis on interleukin-6 in COVID-19-positive patients with chronic kidney disease

BACKGROUND: In patients with coronavirus disease 2019 (COVID-19) with multiple organ involvement, interleukin-6 (IL-6) is an important biomarker of the hyperinflammatory immune response, cytokine storm, and fatal outcomes. Our research aims to comprehend the value of polysulfone membrane-based hemodialysis (HD), not only in terms of lowering renal load but also in terms of enhancing outcomes by addressing the IL-6 levels in patients with chronic kidney disease (CKD) on maintenance HD (MHD). METHODS: This prospective observational analysis was conducted from July 2020 to January 2022 at a tertiary care hospital in Prayagraj, Uttar Pradesh, India. 181 patients, with a history of CKD on MHD, hospitalized in COVID-19 wards were chosen for this study. The usual baseline blood values of the patients were assessed. HD was done on the Fresenius polysulfone membrane (FX-8) with an effective surface area of 1.4 m2 and an ultrafiltration coefficient of 12 (ml/h × mmHg). Patients' IL-6 levels were initially checked before dialysis, and in patients who survived, they were repeated on the day of discharge. Data were analyzed using SPSS software. A P-value of less than 0.05 was considered statistically significant. RESULTS: Out of a total of 181 patients, 95 were survivors and 86 were non-survivors. Most non-survivors were elderly (P < 0.001). The mean neutrophil-lymphocyte ratio (NLR) and D-dimer levels were substantially greater in non-survivors than in survivors (P < 0.001). Non-survivors had considerably higher mean serum levels of IL-6, creatinine, and urea (P < 0.001). The average number of HD treatments received by survivors was higher (P < 0.001). The relationship between delta IL-6 and delta serum creatinine for survivors had a strong positive correlation of r = 0.775 (P < 0.001). CONCLUSION: This study demonstrates that IL-6 is a subpar predictor of prognosis in convalescent CKD patients with COVID-19. It also emphasizes the use of HD as a life-saving therapeutic strategy that is also cost-effective. Lowering IL-6 levels can both enhance renal outcomes and calm the cytokine storm.