Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;55(2):449-458.
doi: 10.1007/s11255-022-03289-z. Epub 2022 Aug 22.

Chronic hemodialysis patients with COVID-19 cared for by the public health system have higher mortality than those treated in private facilities: analysis of the Brazilian dialysis registry

Helbert do Nascimento Lima  1 , Fabiana Baggio Nerbass  2 , Osvaldo Merege Vieira Neto  3 , Ricardo Sesso  4 , Jocemir Ronaldo Lugon  5 ; Covid19-HD Brazil Investigators
Collaborators, Affiliations

Chronic hemodialysis patients with COVID-19 cared for by the public health system have higher mortality than those treated in private facilities: analysis of the Brazilian dialysis registry

Helbert do Nascimento Lima et al. Int Urol Nephrol. 2023 Feb.

Abstract

Purpose: Brazil is the third country globally in dialysis patients. Little is known about the impact of the type of health insurance on the outcome of these patients after COVID-19.

Methods: We analyzed comorbidities, sociodemographic factors, and dialysis-related parameters from a retrospective cohort study of 1866 Brazilian chronic hemodialysis patients with COVID-19 from Feb 2020-July 2021. We evaluated the influence of health insurance (private vs. public) on the intensive care unit admission and 90 day fatality risk.

Results: From 1866 hemodialysis patients, 455 (24%) were admitted to the intensive care unit, and 350 (19%) died. The mean age was 57.5 years, 88% had public health insurance. Crude case-fatality rate was not different between groups (private vs. public risk ratio 1.11; 95% CI 0.82-1.52, p = 0.498). In fully adjusted multivariate models, patients with private health insurance did not have a higher chance to be admitted to an intensive care unit (odds ratio 0.97; 95% CI 0.63-1.50, p = 0.888), but they presented a lower death risk (hazard ratio 0.56; 95% CI 0.37-0.85, p = 0.006).

Conclusion: The type of health insurance did not influence the access of hemodialysis patients with COVID-19 to an intensive care unit, but patients with private health insurance had a lower mortality risk.

Keywords: COVID-19; Healthcare disparities; Hemodialysis; Intensive care unit; Mortality.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest in relation to the study performed.

Figures

Fig. 1
Fig. 1
Cumulative survival after COVID-19 on hemodialysis patients by the type of health care assistance (Kaplan–Meier method). Log Rank Test, p = 0.458
See this image and copyright information in PMC

References

    1. Brazil (2021) Painel coronavírus. https://covid.saude.gov.br/. Accessed 24 Aug 2021
    1. de Souza WM, Buss LF, Candido DDS, Carrera JP, Li S, Zarebski AE, Pereira RHM, Prete CA, Jr, de Souza-Santos AA, Parag KV, Belotti M, Vincenti-Gonzalez MF, Messina J, da Silva Sales FC, Andrade PDS, Nascimento VH, Ghilardi F, Abade L, Gutierrez B, Kraemer MUG, Braga CKV, Aguiar RS, Alexander N, Mayaud P, Brady OJ, Marcilio I, Gouveia N, Li G, Tami A, de Oliveira SB, Porto VBG, Ganem F, de Almeida WAF, Fantinato F, Macario EM, de Oliveira WK, Nogueira ML, Pybus OG, Wu CH, Croda J, Sabino EC, Faria NR. Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil. Nat Hum Behav. 2020;4(8):856–865. doi: 10.1038/s41562-020-0928-4. - DOI - PubMed
    1. Prichard SS. Comorbidities and their impact on outcome in patients withend-stage renal disease. Kidney Int. 2000;57:S100–S104. doi: 10.1046/j.1523-1755.2000.07417.x. - DOI
    1. Khatri M, Charytan DM, Parnia S, Petrilli CM, Michael J, Liu D, Tatapudi V, Jones S, Benstein J, Horwitz LI. Outcomes among hospitalized chronic kidney disease patients with COVID-19. Kidney 360. 2021;2:1107–1114. doi: 10.34067/KID.0006852020. - DOI - PMC - PubMed
    1. Neves P, Sesso RCC, Thome FS, Lugon JR, Nasicmento MM. Brazilian dialysis census: analysis of data from the 2009–2018 decade. J Bras Nefrol. 2020;42(2):191–200. doi: 10.1590/2175-8239-JBN-2019-0234. - DOI - PMC - PubMed