Chronic Hemodialysis Patients Hospitalized with COVID-19: Short-term Outcomes in the Bronx, New York

Abstract

Background: Patients with ESKD who are on chronic hemodialysis have a high burden of comorbidities that may place them at increased risk for adverse outcomes when hospitalized with COVID-19. However, data in this unique patient population are limited. The aim of our study is to describe the clinical characteristics and short-term outcomes in patients on chronic hemodialysis who require hospitalization for COVID-19.

Methods: We performed a retrospective study of 114 patients on chronic hemodialysis who were hospitalized with COVID-19 at two major hospitals in the Bronx from March 9 to April 8, 2020 during the surge of SARS-CoV-2 infections in New York City. Patients were followed during their hospitalization through April 22, 2020. Comparisons in clinical characteristics and laboratory data were made between those who survived and those who experienced in-hospital death; short-term outcomes were reported.

Results: Median age was 64.5 years, 61% were men, and 89% were black or Hispanic. A total of 102 (90%) patients had hypertension, 76 (67%) had diabetes mellitus, 63 (55%) had cardiovascular disease, and 30% were nursing-home residents. Intensive care unit (ICU) admission was required in 13% of patients, and 17% required mechanical ventilation. In-hospital death occurred in 28% of the cohort, 87% of those requiring ICU, and nearly 100% of those requiring mechanical ventilation. A large number of in-hospital cardiac arrests were observed. Initial procalcitonin, ferritin, lactate dehydrogenase, C-reactive protein, and lymphocyte percentage were associated with in-hospital death.

Conclusions: Short-term mortality in patients on chronic hemodialysis who were hospitalized with COVID-19 was high. Outcomes in those requiring ICU and mechanical ventilation were poor, underscoring the importance of end-of-life discussions in patients with ESKD who are hospitalized with severe COVID-19 and the need for heightened awareness of acute cardiac events in the setting of COVID-19. Elevated inflammatory markers were associated with in-hospital death in patients with ESKD who were hospitalized with COVID-19.

Keywords: COVID-19; New York City; artificial; cardiovascular diseases; chronic; coronavirus infections; dialysis; hospital mortality; kidney failure; renal dialysis; respiration; retrospective studies; severe acute respiratory syndrome coronavirus 2.

Graphical abstract

Figure 1.

Disposition of hospitalized patients on chronic hemodialysis with coronavirus disease 2019 (COVID-19) during the study period.

Figure 2.

Differences in inflammatory markers in those alive compared with those who died during hospitalization, mean with SEM. (A) Initial ferritin was higher in those who died (**P=0.005). (B) Initial and peak lactate dehydrogenase (LDH) were higher in those who died (*P=0.045, **P=0.007). (C) Peak procalcitonin was higher in those who died (*P=0.05). (D) Initial C-reactive protein (CRP) was higher in those who died (**P=0.005). A, alive; D, died.