Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort

Abstract

Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease, related to severe acute respiratory syndrome coronavirus 2 infection. Few data are available in patients with end-stage renal disease (ESRD).

Methods: We conducted an observational cohort study of COVID-19 patients at 11 dialysis centres in two distinct districts of France to examine the epidemiological and clinical characteristics of COVID-19 in this population, and to determine risk factors of disease severity (defined as a composite outcome including intensive care unit admission or death) and mortality.

Results: Among the 2336 patients enrolled, 5.5% had confirmed COVID-19 diagnosis. Of the 122 patients with a follow-up superior to 28 days, 37% reached the composite outcome and 28% died. Multivariate analysis showed that oxygen therapy on diagnosis and a decrease in lymphocyte count were independent risk factors associated with disease severity and with mortality. Chronic use of angiotensin II receptor blockers (ARBs) (18% of patients) was associated with a protective effect on mortality. Treatment with azithromycin and hydroxychloroquine (AZT/HCQ) (46% of patients) were not associated with the composite outcome and with death in univariate and multivariate analyses.

Conclusions: COVID-19 is a severe disease with poor prognosis in patients with ESRD. Usual treatment with ARBs seems to be protective of critical evolution and mortality. There is no evidence of clinical benefit with the combination of AZT/HCQ.

Keywords: COVID-19; angiotensin II receptor blockers; dialysis; hydroxychloroquine; lymphocytes.

Graphical Abstract

FIGURE 1:

Flow chart *P = 0.14, no statistical difference between Marseille and Champagne region for COVID-19 incidence in dialysis patients. ADPC, Association des dialysés Provence Corse; ARDPP, association régionale de promotion dialyse à domicile.

FIGURE 2:

Number of new cases of COVID-19 per week in dialysis patients in Marseille and Champagne region.

FIGURE 3:

Oxygen requirement on diagnosis and during hospitalization according to patient outcome.

FIGURE 4:

Cause of death.

FIGURE 5:

Occurrence of the composite outcome critical evolution (ICU admission or death) according to oxygen therapy on diagnosis and lymphopaenia. (A) Critical evolution according to oxygen therapy on diagnosis: five events (22% of patients) occurred in the group without oxygen therapy on diagnosis and 30 events (54% of patients) in the group without oxygen therapy on diagnosis. (B) Critical evolution according to the tertile of lymphocytes count: 22 events (26% of patients) occurred in group with lymphocytes <0.60 G/L, 16 events (21% of patients) in the group with 0.60 G/L ≤ lymphocytes < 0.95 G/L and 7 events (9% of patients) in the group with lymphocytes ≥0.95 G/L.

FIGURE 6:

Occurrence of the composite outcome critical evolution (ICU admission or death) and death according to chronic ARBs treatment. (A) Critical evolution: four events (18% of patients) occurred in group with ARBs and 41 events (41%) in group without ARBs. (B) Mortality: one event (5% of patients) occurred in group with ARBs and 33 events (33%) in group without ARBs.