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. 2021 Jul 7;10(14):3022.
doi: 10.3390/jcm10143022.

The Impact of Age on Mortality in Chronic Haemodialysis Popu-Lation with COVID-19

Ander Vergara  1   2 , Mireia Molina-Van den Bosch  2 , Néstor Toapanta  1   2 , Andrés Villegas  3 , Luis Sánchez-Cámara  4 , Patricia de Sequera  5 , Joaquín Manrique  6   7 , Amir Shabaka  8 , Inés Aragoncillo  4 , María Carmen Ruiz  9 , Silvia Benito  10 , Emilio Sánchez  11 , María José Soler  1   2
Affiliations

The Impact of Age on Mortality in Chronic Haemodialysis Popu-Lation with COVID-19

Ander Vergara et al. J Clin Med. .

Abstract

Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in haemodialysis are elderly. Herein, we investigated the impact of age on mortality among haemodialysis patients with COVID-19. Data was obtained from the Spanish COVID-19 chronic kidney disease (CKD) Working Group Registry. From 18 March 2020 to 27 August 2020, 930 patients on haemodialysis affected by COVID-19 were included in the Registry. A total of 254 patients were under 65 years old and 676 were 65 years or older (elderly group). Mortality was 25.1% higher (95% CI: 22.2-28.0%) in the elderly as compared to the non-elderly group. Death from COVID-19 was increased 6.2-fold in haemodialysis patients as compared to the mortality in the general population in a similar time frame. In the multivariate Cox regression analysis, age (hazard ratio (HR) 1.59, 95% CI: 1.31-1.93), dyspnea at presentation (HR 1.51, 95% CI: 1.11-2.04), pneumonia (HR 1.74, 95% CI: 1.10-2.73) and admission to hospital (HR 4.00, 95% CI: 1.83-8.70) were identified as independent mortality risk factors in the elderly haemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.68, 95% CI: 0.48-0.96). In conclusion, mortality is dramatically increased in elderly haemodialysis patients with COVID-19. Our results suggest that this high risk population should be prioritized in terms of protection and vaccination.

Keywords: COVID-19; SARS-CoV-2; elderly; haemodialysis; mortality.

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Conflict of interest statement

A.V. reports personal fees and non-financial support from Mundipharma, outside the submitted work. M.J.S. reports personal fees from NovoNordisk, Janssen, AstraZeneca, Fresenius, Mundipharma, Pfizer, Bayer and Vifor, grants and non-financial support from Boehringer, and non-financial support from Eli Lilly and Esteve outside of the submitted work. Authors declare that the results presented in this paper have not been published previously in whole or part, except in abstract format.

Figures

Figure 1
Figure 1
Study flow diagram. KRT: Kidney Replacement Therapy.
Figure 2
Figure 2
Kaplan–Meier survival curves for all-cause mortality in the haemodialysis population: distribution by age. (A) Survival differences between elderly (≥65 years-old) and non-elderly (<65 years-old) population; (B) Survival differences within haemodialysis population by age range. HD: Haemodialysis.
Figure 3
Figure 3
Hospitalization and mortality in Spanish general population and haemodialysis patients with COVID-19. (A) Percentage of patients admitted to hospital by age range in the general population and haemodialysis patients. (B) Mortality by age range in the general population and haemodialysis patients. General population data was obtained from the Spanish National Epidemiological Surveillance Network between 31 January 2020 and 27 August 2020 [10,11]. Haemodialysis data obtained from the Spanish COVID-19 Working Group database.
See this image and copyright information in PMC

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