Patients on maintenance dialysis who contract COVID-19 have a nearly 25% mortality rate, much higher than those who do not get the disease, according to a study conducted at a mid-size national dialysis provider.
The retrospective study, led by Eduardo Lacson, Jr, MD, MPH, of Tufts Medical Center in Boston, Massachusetts, included 7948 patients receiving maintenance dialysis at Dialysis Clinic Inc., a national not-for-profit dialysis provider with more than 15,000 maintenance dialysis patients at 260 outpatient dialysis clinics in 29 states. The study only included clinics with at least 1 COVID-19 case.
COVID-19 developed in 438 patients (5.5%) from February to June 2020. Of these, 109 (24.9%) died, with a mean time to death of 16.7 days, Dr Lacson and colleagues reported online in the American Journal of Kidney Diseases. By comparison, the mortality rate among the non-COVID patients was 3.7% (275 of 7510 patients). Older age, heart disease, and markers of frailty were associated with COVID-related mortality.
Among the COVID-19 patients, ages 50 to 59, 60 to 69, 70 to 79, and 80 years or older were significantly associated with approximately 5.6-, 8.5-, 9.5-, and 15.6-fold increased odds of death, respectively, compared with an age younger than 50 years, the investigators reported. Congestive heart failure was significantly associated with approximately 2-fold increased odds of death. Peripheral vascular disease and wheelchair use were significantly associated with approximately 3.1- and 3.4-fold increased odds.
Risk factors for infection with SARS-CoV-2, the novel coronavirus that causes COVID-19, included male sex, Black race, in-center dialysis, treatment at an urban clinic, residence in a congregate setting, and a greater comorbidity burden, according to the investigators.
In a subgroup analysis, 31.9% of patients living in a congregate setting contracted COVID-19 compared with only 2.8% of those residing in a non-congregate setting. Patients who lived in a congregate setting had 17-fold greater odds of infection compared with those who did not.
“These data suggest that the maintenance dialysis population requires substantial support during the pandemic, whether through expanded testing, early vaccination, or coordination of complex care, the investigators concluded.
With respect to study limitations, the authors noted that because they defined all patients with a positive SARS-CoV-2 test as having COVID-19, they did not distinguish between symptomatic patients and asymptomatic carriers.
Disclosure: This clinical trial was supported by Dialysis Clinic Inc. Please see the original reference for a full list of authors’ disclosures.
Hsu CM, Weiner DE, Aweh G, et al. COVID-19 infection among US dialysis patients: risk factors and outcomes from a national dialysis provider. Published online January 16, 2021. Am J Kidney Dis. doi:10.1053/j.ajkd.2021.01.003