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Multicenter Study
. 2022 May 30;12(5):e054869.
doi: 10.1136/bmjopen-2021-054869.

Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK

Haresh Selvaskandan  1   2 , Katherine L Hull  3   2 , Sherna Adenwalla  3   2 , Safa Ahmed  4 , Maria-Cristina Cusu  5 , Matthew Graham-Brown  3   2 , Laura Gray  6 , Matt Hall  7 , Rizwan Hamer  4 , Ammar Kanbar  8 , Hemali Kanji  4 , Mark Lambie  9 , Han Sean Lee  7 , Khalid Mahdi  10 , Rupert Major  3   11 , James F Medcalf  3   2 , Sushiladevi Natarajan  3 , Boavojuvie Oseya  5 , Stephanie Stringer  12 , Matthew Tabinor  12 , James Burton  3   2
Affiliations
Multicenter Study

Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK

Haresh Selvaskandan et al. BMJ Open. .

Abstract

Objectives: To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis.

Setting: A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK.

Participants: All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres.

Exposure: The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19.

Main outcomes and measures: Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation.

Results: 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings.

Conclusion: The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.

Keywords: COVID-19; dialysis; epidemiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Forest plot demonstrating the ORs on adjusted analysis when comparing the risk of developing severe COVID-19 between the most socially deprived (first to third deprivation ranks quartiles) and the least socially deprived areas (fourth deprivation rank quartiles).
Figure 2
Figure 2
The incidence of severe and non-severe cases over time. (A) The cumulative percentage of cases over time for severe (n=174, 100%) an non-severe cases (n=77, 100%) was similar. (B) Histogram showing frequency of cases in days relative to the reference case, defined as the first positive case in our study cohort. The data are not normally distributed, and as such was explored with non-parametric methods. (C) The median number of days from the reference case for the presentation of severe and non severe cases was 32 and 33, respectively. A Mann-Whitney U test found this difference to be insignificant. Taken together, these data suggest that time dependency was unlikely to influence associations reported with disease severity.
See this image and copyright information in PMC

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