Pulmonary Embolism in ESKD and COVID-19 – A Known Common Problem Yet Too Much Unknown

Abstract

Venous thromboembolism (VTE) is common in COVID-19 infection, particularly in those with severe disease. Here we report a case of pulmonary embolism (PE) in an end stage kidney disease (ESKD) patient on maintenance haemodialysis with COVID-19 infection. The clinical manifestations of PE in this case were non-specific, and were masked by the other concurrent illnesses. Patient was persistently hypoxic despite optimal management of the other concurrent illnesses, and PE was eventually diagnosed based on CT pulmonary angiogram. This case highlights a few important issues that, VTE incidence is unacceptably high despite pharmacological prophylaxis, and clinical manifestations of PE in CKD patients with COVID-19 are non-specific and are frequently thought to be due to other concurrent illnesses. Optimal treatment of PE in COVID-19 is unknown, and data is even more scarce in CKD population. Current treatment recommendations are largely extrapolated from data of non-COVID-19 population, though large prospective trials are underway.