Chronic Hemodialysis Patients Hospitalized with COVID-19: Short-term Outcomes in the Bronx, New York

Abstract

BackgroundPatients with ESKD who are on chronic hemodialysis have a high burden of comorbidities that may place them at increased risk for adverse outcomes when hospitalized with COVID-19. However, data in this unique patient population are limited. The aim of our study is to describe the clinical characteristics and short-term outcomes in patients on chronic hemodialysis who require hospitalization for COVID-19.MethodsWe performed a retrospective study of 114 patients on chronic hemodialysis who were hospitalized with COVID-19 at two major hospitals in the Bronx from March 9 to April 8, 2020 during the surge of SARS-CoV-2 infections in New York City. Patients were followed during their hospitalization through April 22, 2020. Comparisons in clinical characteristics and laboratory data were made between those who survived and those who experienced in-hospital death; short-term outcomes were reported.ResultsMedian age was 64.5 years, 61% were men, and 89% were black or Hispanic. A total of 102 (90%) patients had hypertension, 76 (67%) had diabetes mellitus, 63 (55%) had cardiovascular disease, and 30% were nursing-home residents. Intensive care unit (ICU) admission was required in 13% of patients, and 17% required mechanical ventilation. In-hospital death occurred in 28% of the cohort, 87% of those requiring ICU, and nearly 100% of those requiring mechanical ventilation. A large number of in-hospital cardiac arrests were observed. Initial procalcitonin, ferritin, lactate dehydrogenase, C-reactive protein, and lymphocyte percentage were associated with in-hospital death.ConclusionsShort-term mortality in patients on chronic hemodialysis who were hospitalized with COVID-19 was high. Outcomes in those requiring ICU and mechanical ventilation were poor, underscoring the importance of end-of-life discussions in patients with ESKD who are hospitalized with severe COVID-19 and the need for heightened awareness of acute cardiac events in the setting of COVID-19. Elevated inflammatory markers were associated with in-hospital death in patients with ESKD who were hospitalized with COVID-19.

COVID-19 Infection in ESKD: Findings from a Prospective Disease Surveillance Program at Dialysis Facilities in New York City and Long Island

“…Alternatively, it may represent a higher risk of sudden death in ESKD 3 related to COVID-19 infection. 2 Exploring the relationship between race and other demographic factors and mortality among COVID-19-positive/symptomatic patients will be an important avenue of study.…”

“…Our sample size is larger than those of previous studies and more diverse with respect to ethnicity, race, and socioeconomic status. 1,2 We were also able to trace out-of-hospital deaths.…”

“…As the pandemic continued, information regarding the effects of COVID-19 on patients on dialysis became available. 1,2 Generally, patients on dialysis have high rates of hospitalizations and mortality for cardiovascular and infectious causes, 3 with infections the second most common cause of death. 4 In the setting of COVID-19, patients on dialysis have specific risk factors associated with this highly contagious pathogen: older age 3 and high prevalence rates of diabetes mellitus and hypertension, all of which are associated with worse outcomes in COVID-19.…”

“…4 In the setting of COVID-19, patients on dialysis have specific risk factors associated with this highly contagious pathogen: older age 3 and high prevalence rates of diabetes mellitus and hypertension, all of which are associated with worse outcomes in COVID-19. 1,2,5 Studies thus far have not described the natural history, spectrum of disease, or effects of COVID-19 on patients on dialysis.…”

COVID-19 in Hospitalized Patients on Chronic Peritoneal Dialysis: A Case Series

“…This pandemic has affected the ESKD population, with high mortality rates reported among patients on hemodialysis (HD) [3]. However, the degree to which it has affected the PD population in the United States (US) has not yet been elucidated [4, 5]. Herein, we describe the clinical characteristics, presentations, clinical course, and outcomes of ESKD patients on PD hospitalized with COVID-19.…”