الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The study was performed on 146 subjects; 62 healthy control individuals and 84 CKD patients. In which; 44 of group II CKD patients were tested negative for COVID-19 and 40 of group II CKD patients were tested positive for COVID-19.
The study aims to investigate CD4 T-helper lymphocytes levels of CKD patients. As well as, investigating the effect of COVID-19 infected CKD patients on CD4 T-helper lymphocytes levels.
Patients with CKD especially ESRD exhibit reduced numbers of total circulating lymphocytes especially T cells (CD3+ lymphocytes) accompanied by a profound decrease in T cell compositions; CD4+ lymphocytes and CD8+ lymphocytes.
Marked alterations in the immune system occurred in positive COVID-19 tested CKD patients, leading to an immunosuppressed state with a markedly DROP in absolute lymphocytic counts, total circulating T lymphocytes (CD3+ T lymphocytes), T-cytotoxic lymphocytes (CD8+ T lymphocytes), and T-helper lymphocytes (CD4+ T lymphocytes).
Besides the immune system disturbance that occurred due to both CKD progression and COVID-19 infection; other hematological and blood chemistry parameters are also affected.
Renal functions as blood urea and serum uric acid showed elevated levels across whole CKD patients with higher values in positive COVID-19 CKD patients. The matter that rolling the patient into a vicious cycle of CKD as a co-morbidity factor in COVID-19 infection and the further aggravating renal impairment caused by the COVID-19 infection.
Liver functions as ALT, AST, TP and serum albumin were disturbed among positive COVID-19 tested CKD patients indicating an active liver injury process occurring mainly due to COVID-19 infection; while showing variable ranges between the negative COVID-19 tested CKD patients.
Chronic kidney disease patients show different grades of anemia due to different causes of anemia as specifically impaired erythropoietin levels that are excreted mainly from kidneys and iron deficiency anemia especially in advanced CKD cases. Platelets show variable ranges of thrombocytopenia, normal values, and thrombocytosis as they have a multifactorial affection of hematopoietic cells depression, reactive elevation after starting treatment, cytokine storm in positive COVID-19 CKD patients causing platelets release and/or their consumption in disseminated coagulopathy cases.
Conclusion
In conclusion, chronic kidney disease causes marked alterations in the immune system, including persistent systemic inflammation and acquired immunosuppression. The most common alterations in the immune system in CKD patients are characterized by B and T cell phagocytic dysfunction and increased concentrations of pro-inflammatory cytokines and inflammatory cells.
Although COVID-19 infection is considered mainly as respiratory disease, it suppresses body immune responses sharply.
CD4+ T lymphocyte levels decrease alongside the decrease in eGFR levels among negative COVID-19 PCR-tested CKD patients.
While CD4+ T lymphocyte levels dropped markedly to lower levels among positive COVID-19 PCR-tested CKD patients.
So, CKD combined with COVID-19 infection together are signs of bad prognosis to those patients, which require special care to be capable of overcoming the serious illness.
Recommendations
Recommendations
- Good screening of CKD patients with proper management to the new cases.
- Establishing a linked database to document new CKD cases, follow up current cases and determine patients who undergo dialysis and/or renal transplantation.
- Ensure well-equipped quarantine hospitals as dialysis units to those CKD cases catching COVID-19 infection.
- Early and proper dealing with COVID-19 cases to improve their morbidity with decrease further renal impairment complications.
- Activate the government campaign for mass COVID-19 vaccination to the high risk group as CKD patients.
- Studying in larger numbers of patients and multi-centric studies should be performed that will increase statistical power by alleviating possible bias and difference of the studied groups.
- Further studying the other immune system elements affected by CKD that increases its morbidity.