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. 2021 Feb 22;193(8):E278-E284.
doi: 10.1503/cmaj.202601. Epub 2021 Feb 4.

COVID-19 in patients undergoing long-term dialysis in Ontario

Leena Taji  1 , Doneal Thomas  1 , Matthew J Oliver  1 , Jane Ip  1 , Yiwen Tang  1 , Angie Yeung  1 , Rebecca Cooper  1 , Andrew A House  1 , Phil McFarlane  1 , Peter G Blake  2
Affiliations

COVID-19 in patients undergoing long-term dialysis in Ontario

Leena Taji et al. CMAJ. .

Abstract

Background: Patients undergoing long-term dialysis may be at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and of associated disease and mortality. We aimed to describe the incidence, risk factors and outcomes for infection in these patients in Ontario, Canada.

Methods: We used linked data sets to compare disease characteristics and mortality between patients receiving long-term dialysis in Ontario who were diagnosed SARS-CoV-2 positive and those who did not acquire SARS-CoV-2 infection, between Mar. 12 and Aug. 20, 2020. We collected data on SARS-CoV-2 infection prospectively. We evaluated risk factors for infection and death using multivariable logistic regression analyses.

Results: During the study period, 187 (1.5%) of 12 501 patients undergoing dialysis were diagnosed with SARS-CoV-2 infection. Of those with SARS-CoV-2 infection, 117 (62.6%) were admitted to hospital and the case fatality rate was 28.3%. Significant predictors of infection included in-centre hemodialysis versus home dialysis (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.59-4.05), living in a long-term care residence (OR 7.67, 95% CI 5.30-11.11), living in the Greater Toronto Area (OR 3.27, 95% CI 2.21-4.80), Black ethnicity (OR 3.05, 95% CI 1.95-4.77), Indian subcontinent ethnicity (OR 1.70, 95% CI 1.02-2.81), other non-White ethnicities (OR 2.03, 95% CI 1.38-2.97) and lower income quintiles (OR 1.82, 95% CI 1.15-2.89).

Interpretation: Patients undergoing long-term dialysis are at increased risk of SARS-CoV-2 infection and death from coronavirus disease 2019. Special attention should be paid to addressing risk factors for infection, and these patients should be prioritized for vaccination.

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Conflict of interest statement

Competing interests: Leena Taji, Doneal Thomas, Jane Ip, Yiwen Tang, Angie Yeung and Rebecca Cooper are salaried employees of Ontario Renal Network, Ontario Health. Matthew Oliver, Phil McFarlane and Peter Blake are contracted Medical Leads at Ontario Renal Network, Ontario Health. Matthew Oliver is owner of Oliver Medical Management Inc., which licenses Dialysis Management Analysis and Reporting System software. He has received honoraria for speaking from Baxter Healthcare and participated on Advisory Boards for Janssen and Amgen. Peter Blake has received honoraria from Baxter Global for speaking engagements. Andrew House has received honoraria from Baxter for speaking engagements. Phil McFarlane has received consultant or lecture fees from Amgen, Astra-Zeneca, Bayer, BMS, Boehringer-Ingelheim, GSK, Janssen, Lilly, Novartis, Otsuka, Sanofi-Aventis, Servier and Vifor. He has also received research grants from Amgen, Astra-Zeneca, Bayer, Boehringer-Ingelheim and Otsuka. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Flow chart for selection of the cohort of patients undergoing long-term dialysis in Ontario. Note: ORRS = Ontario Renal Reporting System, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
Figure 2:
Figure 2:
Number of new cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patients undergoing long-term dialysis in Ontario and the Ontario general population, per reporting week, as of Aug. 20, 2020. Note: We used 12 501 as the denominator for the dialysis population; peak incidence was 33 cases = 264 per 100 000 population for the week ending Apr. 23, 2020. We used 14 745 040 as the denominator for the general Ontario population for this period; peak incidence was 3918 cases = 27 per 100 000 population for the week ending Apr. 23, 2020.
Figure 3:
Figure 3:
Summary of multivariable logistic regression predicting risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patients undergoing long-term dialysis (no. of patients with a diagnosis of SARS-CoV-2 infection = 187; no. without SARS-COV-2 infection = 12 246). Reference categories: age younger than 50 years, ethnicity White, geographic location outside the Greater Toronto Area (GTA), modality home dialysis, highest 2 income quintiles, 5 or fewer years undergoing dialysis, sex female and all other variables were No. Note: CI = confidence interval, OR = odds ratio. We excluded 68 patients from the cohort without SARS-CoV-2 infection because linkage to neighbourhood income quintiles was not possible.
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