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. 2021 Jan 5;9(1):47.
doi: 10.3390/healthcare9010047.

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients

Chun-Yu Chen  1   2 , Shih-Chieh Shao  3   4 , Yih-Ting Chen  1   2 , Cheng-Kai Hsu  1   2 , Heng-Jung Hsu  1   2 , Chin-Chan Lee  1   2 , Chiao-Yin Sun  1   2 , Yung-Chan Chen  2   5 , Ming-Jui Hung  6 , I-Wen Wu  1   2
Affiliations

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients

Chun-Yu Chen et al. Healthcare (Basel). .

Abstract

Hemodialysis (HD) patients are highly susceptible to COVID-19 infection. However, comprehensive assessments of current evidence regarding COVID-19 in HD patients remain incomplete. We systematically searched PUBMED and EMBASE for articles published on incidence or mortality of COVID-19 infection in HD patients until September 2020. Two independent researchers extracted data and study-level risk of bias across studies. We conducted meta-analysis of proportions for incidence and mortality rate. Study heterogeneity and publication bias were assessed. A total of 29 articles with 3261 confirmed COVID-19 cases from a pool of 396,062 HD patients were identified. Incidence of COVID-19 in these HD patients was 7.7% (95% CI: 5.0-10.9%; study heterogeneity: I2 = 99.7%, p < 0.001; risk of publication bias, Egger's test, p < 0.001). Overall mortality rate was 22.4% (95% CI: 17.9-27.1%; study heterogeneity: I2 = 87.1%, p < 0.001; risk of publication bias, Egger's test: p = 0.197) in HD patients with COVID-19. Reported estimates were higher in non-Asian than Asian countries. Quality of study may affect the reported incidence but not the mortality among studies. Both incidence and mortality of COVID-19 infection were higher in HD patients. Available data may underestimate the real incidence of infection. International collaboration and standardized reporting of epidemiological data should be needed for further studies.

Keywords: COVID-19; hemodialysis; incidence; meta-analysis; mortality; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of literature search and selection.
Figure 2
Figure 2
Incidence rate of COVID-19 infection in patients with hemodialysis. The study of Li J et al [13]. reported two independent cohorts that were analyzed separately for meta-analysis. HD, hemodialysis; CI, confidential interval.
Figure 3
Figure 3
Treatment regimen used and proportion of high mortality (>30%) in different studies. Three main patterns were identified among 11 studies. Chi-square test, p = 0.587.
Figure 4
Figure 4
Mortality rate in hemodialysis patients with COVID-19 infection. The study of Li J et al [13]. reported two independent cohorts that were analyzed separately for meta-analysis. The second cohort of Li J et al. reported mortality in 57 deaths from 639 COVID-19 cases (all cases showed feature of viral pneumonitis and 109 were further confirmed by nuclear acid testing). HD, hemodialysis; CI, confidential interval. HD, hemodialysis; CI, confidential interval.
Figure 5
Figure 5
Impact of use of isolation strategies on the outcome of COVID-19 infection in HD patients. The impacts of applying isolation strategies at HD facilities on the (a) incidence (p = 1.0) and (b) mortality (p = 0.088) of COVID-19 was not significant. p value between groups by using Fisher’s exact test.
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