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. 2021 May;77(5):748-756.e1.
doi: 10.1053/j.ajkd.2021.01.003. Epub 2021 Jan 17.

COVID-19 Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider

Caroline M Hsu  1 , Daniel E Weiner  1 , Gideon Aweh  2 , Dana C Miskulin  1 , Harold J Manley  2 , Carol Stewart  2 , Vlad Ladik  2 , John Hosford  2 , Edward C Lacson  2 , Douglas S Johnson  2 , Eduardo Lacson Jr  3
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COVID-19 Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider

Caroline M Hsu et al. Am J Kidney Dis. 2021 May.

Abstract

Rationale & objective: During the coronavirus disease 2019 (COVID-19) pandemic, patients receiving maintenance dialysis are a highly vulnerable population due to their comorbidities and circumstances that limit physical distancing during treatment. This study sought to characterize the risk factors for and outcomes following COVID-19 in this population.

Study design: Retrospective cohort study.

Setting & participants: Maintenance dialysis patients in clinics of a midsize national dialysis provider that had at least 1 patient who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from February to June 2020.

Predictors: Demographics, dialysis characteristics, residence in a congregated setting, comorbid conditions, measurements of frailty, and use of selected medications.

Outcomes: COVID-19, defined as having a positive SARS-CoV-2 test result, and all-cause mortality among those with COVID-19.

Analytical approach: Logistic regression analyses conducted to identify clinical characteristics associated with COVID-19 and risk factors associated with mortality among patients following COVID-19.

Results: 438 of 7948 (5.5%) maintenance dialysis patients developed COVID-19. Male sex, Black race, in-center dialysis (vs home dialysis), treatment at an urban clinic, residence in a congregate setting, and greater comorbidity were associated with contracting COVID-19. Odds of COVID-19 were 17-fold higher for those residing in a congregated setting (odds ratio [OR], 17.10 [95% CI, 13.51-21.54]). Of the 438 maintenance dialysis patients with COVID-19, 109 (24.9%) died. Older age, heart disease, and markers of frailty were associated with mortality.

Limitations: No distinction was detected between symptomatic and asymptomatic SARS-CoV-2 positivity, with asymptomatic screening limited by testing capacity during this initial COVID-19 surge period.

Conclusions: COVID-19 is common among patients receiving maintenance dialysis, particularly those residing in congregate settings. Among maintenance dialysis patients with COVID-19, mortality is high, exceeding 20%.

Keywords: coronavirus disease 2019 (COVID-19); death; dialysis; dialysis clinic; end-stage kidney disease (ESKD); end-stage renal disease (ESRD); epidemiology; mortality; nursing home; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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Graphical abstract
Figure 1
Figure 1
The patient flowchart tracks the clinical course of maintenance dialysis patients with SARS-CoV-2 infection (diagnosed COVID-19) treated in DCI clinics. ED, emergency department; DCI, Dialysis Clinic Inc; HD, hemodiaysis. ∗Hospitalization was defined as being in the ED or hospital on the date of COVID-19 diagnosis or within 30 days thereafter.
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