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. 2023 Mar 22;24(1):67.
doi: 10.1186/s12882-023-03121-5.

Prevalence and predictors of outcomes among ESRD patients with COVID-19

Claire S Baptiste  1 , Esther Adegbulugbe  2 , Divya Shankaranarayanan  2 , Zahra Izzi  3 , Samir Patel  4 , Rasha Nakity  2 , Richard L Amdur  5 , Dominic Raj  6
Affiliations

Prevalence and predictors of outcomes among ESRD patients with COVID-19

Claire S Baptiste et al. BMC Nephrol. .

Abstract

Background: End-stage renal disease patients on hemodialysis (ESRD) patients are at high risk for contracting COVID-19. In this propensity matched cohort study, we examined the prevalence of COVID-19 in emergency room (ER) patients and examined whether clinical outcomes varied by ESRD status.

Methods: Patients who visited George Washington University Hospital ER from April 2020 to April 2021 were reviewed for COVID-19 and ESRD status. Among COVID-positive ER patients, the propensity for ESRD was calculated using a logistic regression model to create a propensity-matched sample of ESRD vs non-ESRD COVID-19 patients. A multivariable model examined whether ESRD was an independent predictor of death and other outcomes in COVID-19 patients.

Results: Among the 27,106 ER patients, 2689 of whom were COVID-positive (9.9%). The odds of testing positive for COVID-19 were 0.97 ([95% CI: 0.78-1.20], p = 0.76) in ESRD vs non-ESRD patients after adjusting for age, sex, and race. There were 2414 COVID-positive individuals with non-missing data, of which 98 were ESRD patients. In this COVID-positive sample, ESRD patients experienced a higher incidence of stroke, sepsis, and pneumonia than non-ESRD individuals. Significant independent predictors of death included age, race, sex, insurance status, and diabetes mellitus. Those with no insurance had odds of death that was 212% higher than those with private insurance (3.124 [1.695-5.759], p < 0.001). ESRD status was not an independent predictor of death (1.215 [0.623-2.370], p = 0.57). After propensity-matching in the COVID-positive patients, there were 95 ESRD patients matched with 283 non-ESRD individuals. In this sample, insurance status continued to be an independent predictor of mortality, while ESRD status was not. ESRD patients were more likely to have lactic acidosis (36% vs 15%) and length of hospital stay ≥ 7 days (48% vs 31%), but no increase in odds for any studied adverse outcomes.

Conclusions: In ER patients, ESRD status was not associated with higher odds for testing positive for COVID-19. Among ER patients who were COVID positive, ESRD was not associated with mortality. However, insurance status had a strong and independent association with death among ER patients with COVID-19.

Keywords: COVID-19; Death; Dialysis; End‐stage renal disease; Kidney; Risk factors.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient Flowchart. The patient flowchart depicts the screening process of patients that visited the emergency department between April 1, 2020 and April 1, 2021. Abbreviations: ER, emergency room, ESRD, end stage renal disease
See this image and copyright information in PMC

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