Predictors of Mortality in Hemodialyzed Patients after SARS-CoV-2 Infection

Abstract

Introduction: The determinants of COVID-19 mortality are well-characterized in the general population. Less numerous and inconsistent data are among the maintenance hemodialysis (HD) patients, who are the population most at risk of an unfavorable prognosis. Methods: In this retrospective cohort study we included all adult HD patients from the Pomeranian Voivodeship, Poland, with laboratory-confirmed SARS-CoV-2 infection hospitalized between 6 October 2020 and 28 February 2021, both those who survived, and also those who died. Demographic, clinical, treatment, and laboratory data on admission, were extracted from the electronic medical records of the dedicated hospital and patients’ dialysis unit, and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with 3-month all-cause mortality. Results: The 133 patients (53.38% males) aged 73.0 (67–79) years, with a median duration of hemodialysis of 42.0 (17–86) months, were included in this study. At diagnosis, the majority were considered to have a mild course (34 of 133 patients were asymptomatic, another 63 subjects presented mild symptoms), while 36 (27.07%) patients had low blood oxygen saturation and required oxygen supplementation. Three-month mortality was 39.08% including an in-hospital case fatality rate of 33.08%. Multivariable logistic regression showed that the frailty clinical index of 4 or greater (OR 8.36, 95%CI 1.81–38.6; p < 0.01), D-Dimer of 1500 ng/mL or greater (6.00, 1.94–18.53; p < 0.01), and CRP of >118 mg/L at admission (3.77 1.09–13.01; p = 0.04) were found to be predictive of mortality. Conclusion: Very high 3-month all-cause mortality in hospitalized HD patients was determined mainly by frailty. High CRP and D-dimer levels upon admission further confer mortality risk.

COVID-19–related clinical outcomes among Korean hemodialysis patients

“…The COVID-19 Task Force Team not only published a COVID-19 prevention guideline [8] but also proposed adequate vaccination and treatment policies to the KDCA, which resulted in lower rates of disease incidence and mortality among HD units [15]. Previous studies have suggested the proportion of asymptomatic SARS-CoV-2 infection among HD patients is approximately 25% [16,17]. Our study demonstrated a higher prevalence of asymptomatic infection (33.9%) compared to previous studies.…”

Angiotensin Converting Enzyme Inhibitors May Increase While Active Vitamin D May Decrease the Risk of Severe Pneumonia in SARS-CoV-2 Infected Patients with Chronic Kidney Disease on Maintenance Hemodialysis

“…The predictive value of inflammation level and lymphopenia concerning the progression of COVID-19 and a poor outcome was reported in previous studies [ 20 , 38 ]. In our recent study, high CRP and D-dimer levels upon admission were strongly associated with a 3-month mortality risk in HD patients [ 39 ]. Other studies also show a predictive value of blood oxygenation indices for the severity of pneumonia and mortality of COVID-19 patients [ 21 , 40 , 41 ].…”

“…However, research into vitamin D supplementation in the prevention and treatment of COVID-19 provides inconsistent results [ 48 , 49 ]. In the recent study, we originally found that in HD patients who were treated with active vitamin D, there may be a lower risk of 3 month death from COVID-19 [ 39 ]. There was substantial clinical and methodological heterogeneity of the conducted studies, mainly because of different supplementation strategies, formulations, vitamin D status of participants, and reported outcomes [ 50 ].…”

COVID-19 vaccination reduces mortality in patients on maintenance hemodialysis

“…Secondly, although both analyzes were performed in the same dialysis centers and the two cohorts mostly overlap, they were not the same. Therefore, it cannot be excluded that the results of the study may be influenced by the fact that the patients with the greatest frailty and worst prognosis have died during the first waves of the pandemic and were no longer on dialysis during the second study period ( 15 ). Finally, due to the nature of the data register, we did not have individual patient data that would allow us to compare the characteristics of the vaccinated and non-vaccinated groups and perform any multivariable analysis.…”