Coronavirus Disease 2019 in Patients With End-Stage Kidney Disease on Hemodialysis in Guatemala

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) is public health concern across the world. Data on the epidemiology among patients on hemodialysis in Latin America and low- and middle-income countries are limited.

Methods: Using electronic medical records from the second largest dialysis network in Guatemala, we performed a retrospective analysis of all adult patients on hemodialysis with the diagnosis of COVID-19 to estimate incidence of infection and to describe the demographics, comorbidities, and outcomes. We stratified incidence rate by region. We reviewed data from May 1 to July 31, 2020, with outcome data ascertained up to August 28, 2020.

Results: Of 3201 patients undergoing hemodialysis, 325 patients were diagnosed with COVID-19 (incidence rate 102/1000 patients on hemodialysis, compared with 3/1000 in the general population). Incidence was higher in the Central region (207/1000) and lowest in the Southeast region (33/1000), and unlike in the general population, the incidence was lower in Guatemala City. The mean age of patients diagnosed with COVID-19 was 51.1 years (standard deviation [SD] 14.8 years), and 84 (25.8%) were female. The median length of hospital stay was 12 days (interquartile range [IQR] 10-16 days). Two hundred twenty-nine (69.8%) of the patients recovered, 90 patients died (27.7%), and 6 (1.8%) patients were still in the hospital at the time of last follow-up.

Conclusion: The incidence of diagnosed COVID-19 in Guatemalan patients on hemodialysis was much higher than reported in the general population, with outcomes similar to those described in high-income countries. Rural regions had higher incidence rates than the major metropolitan area.

Keywords: CKD; COVID-19; ESKD; Guatemala; dialysis; global health; hemodialysis.

Graphical abstract

Figure 1

Incidence rates of severe acute respiratory syndrome coronavirus 2 infection by Guatemalan region and dialysis center. ∗Southwest region combined with the Northwest region. ∗∗Included 6 dialysis centers with the highest incidence of severe acute respiratory syndrome coronavirus 2 infection in Guatemala. (Map data courtesy 2020 INEGI/Google Maps.)

Figure 2

Cumulative counts of patients positive for severe acute respiratory syndrome coronavirus 2 by clinical status in the Guatemalan Social Security Institute (infected, recovered, or died).

Figure 3

Symptoms by gender. Most of the patients presented with fever. Males were more prone to present with fever than females.

Figure 4

Death rates by age group and diabetic status. (A) The death rate was lower among those ≤45 years of age and markedly higher among those ≥60 years of age. (B) The death rate is higher among those with diabetes.