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. 2024 Dec;56(1):2343890.
doi: 10.1080/07853890.2024.2343890. Epub 2024 May 13.

Dialysis parameters associated with SARS-CoV-2 infection and prognosis in end-stage kidney disease

Rodrigo Bezerra  1   2 , Audes D M Feitosa  2 , Odilson M Silvestre  3 , Miguel M Fernandes-Silva  4 , Roberto B Amazonas  5 , Flavio Teles  6 , Cibele I S Rodrigues  7 , Jose L Lima-Filho  1 , Andrei C Sposito  8 , Wilson Nadruz Jr  1   8
Affiliations

Dialysis parameters associated with SARS-CoV-2 infection and prognosis in end-stage kidney disease

Rodrigo Bezerra et al. Ann Med. 2024 Dec.

Abstract

Background: The Covid-19 pandemic has affected patients with end-stage kidney disease (ESKD). Whether dialysis parameters have a prognostic value in ESKD patients with Covid-19 remains unclear.

Materials and methods: We retrospectively evaluated clinical characteristics, blood pressure (BP) and dialysis parameters in ESKD patients undergoing maintenance outpatient hemodialysis, with (Covid-ESKD) and without (No-Covid-ESKD) Covid-19, at four Brazilian hemodialysis facilities. The Covid-ESKD (n = 107; 54% females; 60.8 ± 17.7 years) and No-Covid-ESKD (n = 107; 62% females; 58.4 ± 14.6 years) groups were matched by calendar time. The average BP and dialysis parameters were calculated during the pre-infection, acute infection, and post-infection periods. The main outcomes were Covid-19 hospitalization and all-cause mortality.

Results: Covid-ESKD patients had greater intradialytic and postdialysis systolic BP and lower predialysis weight, postdialysis weight, ultrafiltration rate, and interdialytic weight gain during acute-illness compared to 1-week-before-illness, while these changes were not observed in No-Covid-ESKD patients. After 286 days of follow-up (range, 276-591), there were 18 Covid-19-related hospitalizations and 28 deaths among Covid-ESKD patients. Multivariable logistic regression analysis showed that increases in predialysis systolic BP from 1-week-before-illness to acute-illness (OR, 95%CI = 1.06, 1.02-1.10; p = .004) and Covid-19 vaccination (OR, 95%CI = 0.16, 0.04-0.69; p = .014) were associated with hospitalization in Covid-ESKD patients. Multivariable Cox-regression analysis showed that Covid-19-related hospitalization (HR, 95%CI = 5.17, 2.07-12.96; p < .001) and age (HR, 95%CI = 1.05, 1.01-1.08; p = .008) were independent predictors of all-cause mortality in Covid-ESKD patients.

Conclusion: Acute Covid-19 illness is associated with variations in dialysis parameters of volume status in patients with ESKD. Furthermore, increases in predialysis BP during acute Covid-19 illness are associated with an adverse prognosis in Covid-ESKD patients.

Keywords: Covid-19; blood pressure; chronic kidney failure; hemodialysis; mortality.

Plain language summary

Dialysis parameters were influenced by SARS-CoV-2 infection and may have prognostic value in patients with Covid-19.Increases in blood pressure during acute Covid-19 illness and the lack of vaccination for Covid-19 were predictors of hospitalization for Covid-19.Hospitalization for Covid-19 and age were independent risk factors for all-cause death.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Univariate logistic regression between hospitalization due to Covid-19 and relevant hemodialysis variables among Covid-ESKD patients.
Figure 2.
Figure 2.
Kaplan-Meier curves for all-cause mortality.
Figure 3.
Figure 3.
Directed acyclic graph (DAG) showing the predictors of the studied outcomes. ΔpredialysisSBP – difference in predialysis systolic blood pressure between acute-illness and 1-week-before-illness.
See this image and copyright information in PMC

References

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