key: cord-0787226-kur9r5n5
authors: Bataille, Stanislas; Pedinielli, Nathalie; Bergougnioux, Jean-Philippe
title: Could ferritin help the screening for COVID-19 in hemodialysis patients?
date: 2020-04-22
journal: Kidney Int
DOI: 10.1016/j.kint.2020.04.017
sha: 7be43355188f62d5b4446c35b5b1e1ee02bfa99c
doc_id: 787226
cord_uid: kur9r5n5

nan

The screening for COronaVirus Infection Disease 2019 (COVID-19) is challenging: many patients are asymptomatic, viral RNA detection in nasopharyngeal swab is falsely negative in 30% and pulmonary CT-SCAN is useless in patients with no pulmonary involvement 1,2 .

In our hemodialysis center, following the K-DIGO recommendations, ferritin levels are measured each month to detect iron deficiency 3 . In April 2020, 22 COVID-19 cases had occurred within the 270 hemodialysis patients of our hemodialysis center. We noticed ferritin levels were very high in these latter ( Figure 1 ). When April monthly ferritin levels were measured, one of our female patients had unusually high ferritin levels of 3806ng/mL versus 531ng/mL previously. A clinical exam revealed no clinical symptoms of COVID-19, but she was tested in nasopharyngeal swab and was revealed positive.

We compared ferritin levels in COVID+ and COVID-infected patients in the hemodialysis patients of our dialysis center in the months preceding viral infection and during infection and found a critical difference (figure 1). In the COVID+ patients, mean ferritin levels in March (before viral infection) and at diagnosis were respectively 584±318 and 1446±1261ng/mL (mean±SD), which was a mean increase of 275%. Interestingly, ferritin levels were elevated at diagnosis in the 5 asymptomatic patients as well as the patients with symptoms (respectively 1209±1292 and 1535±1280ng/mL, mean±SD). Ferritin levels remained stable or decreased very slowly during the whole period of sickness in almost all patients.

Pathophysiological mechanism underlying high ferritin levels is not totally explained at this time, some authors reporting cytokine storm syndrome or macrophage activation syndrome, but in our cohort, ferritin levels were not correlated with c-reactive protein (data not shown) 4,5 .

Screening for COVID-19 in hemodialysis centers is crucial to then isolate infected patients and protect non-infected patients. Ferritin could be a helpful, available and easy to use screening tool for the disease, although we believe that more research is still needed.

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COVID+ (n=22) patients prior to and at COVID diagnosis in hemodialysis patients of our center. A) Comparison of ferritin levels in first week March 2020 (before COVID-19 epidemic had occurred in our center) and at diagnosis of COVID-19 (student t-test). First COVID case in our center as diagnosed on March 18 th 2020. B) Rate of patients with ferritin levels >800ng/mL in first week