Characteristics and Survival Results of Peritoneal Dialysis Patients Suffering from COVID-19 in Turkey: A Multicenter National Study

Abstract

Background: We aimed to study the characteristics of peritoneal dialysis (PD) patients with Coronavirus disease-19 (COVID-19), determine the short-term mortality and other medical complications, and delineate the factors associated with COVID-19 outcome. Methods: In this multicenter national study, we included PD patients with confirmed COVID-19 from 27 centers. The baseline demographic, clinical, laboratory, and radiological data and outcomes at the end of the first month were recorded. Results: We enrolled 142 COVID-19 patients (median age:52 years). 58.2% of patients had mild disease at diagnosis. Lung involvement was detected in 60.8% of patients. 83 (58.4%) patients were hospitalized, 31 (21.8%) patients were admitted to intensive care unit and 24 needed mechanical ventilation. 15 (10.5%) patients were switched to hemodialysis and hemodiafiltration was performed for four (2.8%) patients. Persisting pulmonary symptoms (n=27), lower respiratory system infection (n=12), rehospitalization for any reason (n=24), malnutrition (n=6), hypervolemia (n=13), peritonitis (n=7), ultrafiltration failure (n=7) and in PD modality change (n=8) were reported in survivors. 26 patients (18.31%) died in the first month of diagnosis. The non-survivor group was older, comorbidities were more prevalent. Fever, dyspnea, cough, serious-vital disease at presentation, bilateral pulmonary involvement, and pleural effusion were more frequent among non-survivors. Age (OR:1.102; 95%CI: 1.032-1.117; p: 0.004), moderate-severe clinical disease at presentation (OR:26.825; 95%CI: 4.578-157.172; p<0.001) and baseline CRP (OR:1.008; 95%CI; 1.000-1.016; p:0.040) were associated with first-month mortality in multivariate analysis. Conclusions: Early mortality rate and medical complications are quite high in PD patients with COVID-19. Age, clinical severity of COVID-19, and baseline CRP level are the independent parameters associated with mortality.

COVID-19 and outcomes in Chinese peritoneal dialysis patients

“…The most common symptoms were cough, followed by fever, myalgia and sore throat, similar to the symptoms in the general population. The rates of hospitalisation (16.2%) and mortality (3.8%) were lower than those in previous studies which reported a hospitalisation rate of 33-58% and a mortality rate of 23-52% [11][12][13][14]18,27,28 in dialysis patients with COVID-19, perhaps owing to the lower severity of the Omicron variant and the protection from vaccines. 29,30 However, these rates are still much higher than those reported in the general population (reported hospitalisation rate of approximately 2% and mortality rate of 0.1%), 8,31,32 confirming the poor outcome of COVID-19 in the PD population.…”

“…Although the infection rates among patients of all ages were similar, the rates of hospitalisation, severe disease and mortality were significantly higher in older patients. The higher risk of poor outcome in older people with COVID-19 has been reported in previous studies, 4,12,14 re-emphasising the need to pay more attention to this population during the COVID-19 pandemic.…”

“…11 Other studies with smaller sample sizes showed a significant association between mortality and age, comorbidities, PD vintage, serum albumin, D-dimer levels, need for hospitalisation and hospital-acquired infection in PD patients with COVID-19. [12][13][14] Reports on COVID-19 in PD patients are scarce in China, 15 mostly due to the tight 'zero-COVID' policy in the past 3 years. Since China abandoned its 'zero-COVID' policy in early December 2022, an abrupt increase in infection was reported.…”

“…11 Other studies with smaller sample sizes showed a significant association between mortality and age, comorbidities, PD vintage, serum albumin, d -dimer levels, need for hospitalisation and hospital-acquired infection in PD patients with COVID-19. 12 –14…”

COVID-19 incidence and outcomes among patients with kidney replacement therapy

“…Our study showed the results of short-term fatality and risk factors, which were similar to previous reports from other countries. Previous studies showed that the fatality rates from COVID-19 infection in patients with dialysis were 20% to 30% [ 8 – 10 , 14 , 16 , 28 , 32 – 34 ]. Advanced age, multiple comorbid conditions, diabetes, frailty, and the need for ventilation were risk factors related to death [ 4 , 8 – 10 , 28 , 32 , 33 ].…”