Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK

Abstract

ObjectivesTo assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis.SettingA retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK.ParticipantsAll 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres.ExposureThe utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19.Main outcomes and measuresSevere COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation.Results63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings.ConclusionThe incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.

Assessment of the humoral response to the homologous Gam-COVID-Vac (Sputnik V) or heterologous Sputnik V/mRNA-1273 (Moderna) vaccination against SARS-CoV-2 in dialysis patients

“…It is important to note that the frequency of adverse events was lower than that observed in the general population and no patients required medical support [ 11 ]. However, the median age of the sample analyzed in the present work was higher and the effect of age on the incidence of side effects has already been described in previous studies [ 3 , 13 ]. Moreover, in a study by Polewska and colleagues (2021), adverse events were less frequently observed in dialyzed patients than in the age and sex-matched control group [ 29 ].…”

“…While some authors, including ourselves, could not find an association between these variables and the anti-S-RBD IgG titers [ 24 ], other studies suggest that less comorbidity presence leads to a higher anti-S-RBD IgG titer [ 19 , 23 ]. It is worthy to note that a recent study performed in hemodialysis patients also failed to detect an association between COVID-19 severity and obesity, diabetes, or comorbidity presence [ 3 ], factors that do have an impact on disease severity in the overall population. It appears that these differences are also true for vaccine response.…”

“…This situation is mainly related to a considerably higher mean patient age (approximately 65 years old) and the frequent presence of comorbid conditions such as obesity, diabetes, high blood pressure, socioeconomic deprivation, and frailty that are linked to a more severe COVID-19 course. Fortunately, effective vaccination schemes against SARS-CoV-2 inducing reduction of both infection and the risk of severe COVID-19 have been rapidly developed [ 3 – 6 ]. Moreover, when facing first dose serious adverse effects or dose supply shortages, introduced heterologous vaccination schemes have shown promising results [ 7 – 11 ].…”

Association between Cognitive Impairment and Malnutrition in Hemodialysis Patients: Two Sides of the Same Coin

“…Fourth, the relatively old age of our patients could be a determinant of the obtained results. However, the average age of our patients is similar to that of the dialysis population in Europe [ 45 , 46 , 47 ]. Thus, our population can be regarded as representative of a typical HD population.…”

A Study on Mortality Predictors in Hemodialysis Patients Infected with COVID-19: Impact of Vaccination Status

“…Our findings indicate that factors such as gender, primary kidney disease diagnosis, and comorbidities did not exhibit statistical significance in hemodialyzed patients when considering vaccination status and mortality, except for age and cardiomyopathy. In the study by Rista et al, higher mortality rates were observed in patients undergoing dialysis for diabetic nephropathy ( p < 0.04) and peripheral vascular disease ( p < 0.01) [ 34 ], in contrast to Selvaskandan et al, who found no association between obesity, diabetes status, ethnicity, or Charlson Comorbidity Index with COVID-19 severity [ 35 ]. Kikuchi et al, in their study, used multivariate analysis to show a significant increase in mortality with prolonged duration of dialysis, without a difference in gender or primary disease [ 36 ].…”