The vulnerability of maintenance dialysis patients with COVID-19: mortality and risk factors from a developing country

Abstract

Patients on maintenance dialysis therapy are especially vulnerable to COVID-19 and its complications. This study aimed to assess the incidence, epidemiological characteristics, and mortality rate of COVID-19 among maintenance dialysis patients. This retrospective observational chart review study included 548 patients from all dialysis units in the West Bank of Palestine who acquired COVID-19 between 5 March 2020, and 11 August 2021. We collected data on patients' demographics, clinical features, and outcomes. A multivariable logistic regression model was used to assess independent risk factors for COVID-19-related mortality. The incidence of COVID-19 among maintenance dialysis patients was 35.3%, as 548 out of 1554 patients have tested positive during the study period. Patients on haemodialysis were three times riskier to get infected than those on peritoneal dialysis (37% vs 11.3%). Half (50.2%) of infected patients required hospitalisation, and 24.5% were admitted to an intensive care unit, while the mortality rate stood at 26.8%. Old age, male sex, central venous catheter use, comorbid diabetes, smoking, and having an RH negative blood group type were determined to be significantly associated with increased risk of mortality. In conclusion, the incidence of COVID-19 among Palestinian maintenance dialysis patients was notably high, especially among haemodialysis patients. High rates of hospitalisation, ICU admission, intubation and death were observed, and predictive factors for COVID-19-related mortality were identified. Therefore, the implementation of strict infection control measures and promotion of home dialysis are warranted to reduce the infection rate. KEY MESSAGES The incidence of COVID-19 among Palestinian maintenance dialysis patients was notably high; more than one-third of the total dialysis population acquired COVID-19, with haemodialysis patients being three times more likely to get infected compared to their peritoneal dialysis counterparts. The mortality rate among maintenance dialysis patients was 26.8%, more than 25 times higher than that of the general population. The risk of mortality was significantly increased with age, male sex, smoking, diabetes, and having central venous catheter as vascular access for haemodialysis. Strict infection control measures, as well as the promotion of home dialysis, are necessary to reduce the risk of infection.

Characteristics and prognostic outcome factors between young and elderly peritoneal dialysis patients: a prospective cohort study

“…Both the aging of the population and the outbreak of COVID-19 have led to increased rates of ESRD and the number of elderly patients needing PD (10). In order to improve the prognosis and quality of life in elderly patients with PD, we need to understand the factors influencing their survival and actively prevent and control these risk factors.…”

Improved SARS-CoV-2 neutralization of Delta and Omicron variants of concern after fourth vaccination in hemodialysis patients

“…Continuous variables are expressed as mean ± standard deviation (SD) or median and interquartile range (IQR), as appropriate. Group differences were tested with the χ 2 test or Fisher test. The independent samples t -test or Mann-Whitney-U test was used for continuous variables, as appropriate.…”

“…In hemodialysis patients, a SARS-CoV-2 infection is associated with a markedly increased morbidity and mortality in comparison to the general population with a mortality rate of more than 20% in hospitalized patients [1][2][3] . In the last two years we have learned that double vaccination might not be enough to achieve adequate long-term immune protection in all hemodialysis patients and triple vaccination offers significantly better protection against COVID-19 in this patient group 1,4 .…”

Risk Prediction of Pneumonia in Maintenance Hemodialysis Patients with COVID-19: A Single-center Retrospective Study in China

“…Multiple comorbidities and limited treatment options for COVID-19 infection [5] caused the extremely high infection rate and mortality of MHD patients [3,6,7] . In this regard, if the MHD patients with COVID-19 who are likely to develop pneumonia can be identi ed at an early stage, it can help strengthen surveillance and intervention early to reduce the mortality of MHD patients.…”

“…Older age was one of the independent risk factors for death in COVID-19 patients, which was the common result of most studies, as well as the results of studies in MHD patients, older than 50 ~ 65 years old were the high-risk age for death in MHD patients [4,9,10] . Some studies reported that males might be one of the risk factors [7] , but most studies did not reach relevant conclusions. We found that age over 65 years was a risk factor pneumonia in COVID-19 patients, and gender has no signi cant relationship with pneumonia, which was similar to the results of most studies analyzing risk factors for death.…”