Trajectories of Clinical and Laboratory Characteristics Associated with COVID-19 in Hemodialysis Patients by Survival

Lasky, Rachel; Chaudhuri, Sheetal; Jiao, Yanmei; Larkin, John; Monaghan, Caitlin K.; Winter, Anke; Raimann, Jochen G.; Neri, Luca; Kotanko, Peter; Hymes, Jeffrey; Lee, S.; Usvyat, Len; Kooman, Jeroen P.; Maddux, Franklin W.

doi:10.1101/2021.02.28.21252383

Cited by 3 publications

(5 citation statements)

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“…The selection process is illustrated in Figure 1. The 22 included studies 16–37 were from 17 countries, with a total of 13,191 patients. Meta-analysis of epidemiological, clinical, and radiological data from COVID-19 patients undergoing MHD are summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

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Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

Guan²,

Zhou

et al. 2022

Science Progress

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Introduction: The present study systematically reviewed the clinical features and risk factors in patients undergoing maintenance hemodialysis (MHD) who also acquired coronavirus disease 2019 (COVID-19). More specifically, clinical manifestations, prognosis, and risk factors for death among this population were explored. Method: A literature search using the PubMed, Web of Science, and Embase databases, for articles involving patients with laboratory-confirmed COVID-19 and undergoing MHD published between January 1, 2020, and March 13, 2022, was performed. Random-effects meta-analyses were performed to calculate the weighted mean prevalence and corresponding 95% confidence interval (CI) or weighted means and 95% CI. Heterogeneity among studies was assessed using I2 statistics. Results: Twenty-two studies including 13,191 patients with COVID-19 undergoing MHD were selected. The most common symptoms included fever (53% [95% CI 41%–65%]) and cough (54% [95% CI 48%-60%]); however, 17% (95% CI 11%–22%) of the cases were asymptomatic. In subgroup analysis, the proportion of male patients (65% [95% CI 58%–71%]), and patients with coronary artery disease (30% [95% CI 17%–44%) and chronic obstructive pulmonary disease (9% [95% CI 4%–15%]) was greater in the non-survivor group compared with the survivor group. Furthermore, patients undergoing MHD, who were also positive for COVID-19, exhibited a high mortality rate (24% [95% CI 19%–28%]). Conclusions: MHD patients with COVID-19 may initially present as asymptomatic or with mild symptoms; nevertheless, in this study, these patients exhibited a higher risk for death compared with COVID-19 patients not undergoing MHD. Moreover, male sex and underlying cardiovascular and respiratory diseases increased the mortality risk.

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Section: Resultsmentioning

confidence: 99%

“…Since then, the world has witnessed an increasing number of such cases. 1 Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the putative causative agent of coronavirus disease 2019 (COVID- 19), resulted in this pneumonia. Analysis of the SARS-CoV-2 genome has shown that it is phylogenetically close to SARS-CoV.…”

Section: Introductionmentioning

confidence: 99%

Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

Guan²,

Zhou

et al. 2022

Science Progress

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“…1). These timepoints were selected based off expert knowledge in the domain of medicine and physiology and a prior investigation that estimated the timing of physiological disturbances during the onset of COVID-19 [18].…”

Section: Independent Variablesmentioning

confidence: 99%

“…A past work identified disturbances in physiology start about 14 days before COVID-19, with the most meaningful changes in clinical and laboratory values being seen at presentation with the first signs and symptoms of the disease [18]. Therefore, the most recent value within 14 days of COVID-19 was chosen to provide a representation of the patient's clinical status at presentation with signs of symptoms that led to identification of COVID-19.…”

Section: Independent Variablesmentioning

confidence: 99%

“…Therefore, the most recent value within 14 days of COVID-19 was chosen to provide a representation of the patient's clinical status at presentation with signs of symptoms that led to identification of COVID-19. This prior analysis also showed that clinical and laboratory values > 14 days before COVID-19 presentation were representative of each patient's "normal" physiology before the onset of COVID-19 [18]. Ultimately, this design for predictor variable timing was chosen to show the extent that disturbances in clinical and laboratory values during COVID-19 onset associate with a death event, as well as show the extent that the historic clinical status associates with a death event.…”

Section: Independent Variablesmentioning

confidence: 99%

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Predictors of shorter- and longer-term mortality after COVID-19 presentation among dialysis patients: parallel use of machine learning models in Latin and North American countries

Guinsburg¹,

Jiao

Bessone³

et al. 2022

BMC Nephrol

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Background We developed machine learning models to understand the predictors of shorter-, intermediate-, and longer-term mortality among hemodialysis (HD) patients affected by COVID-19 in four countries in the Americas. Methods We used data from adult HD patients treated at regional institutions of a global provider in Latin America (LatAm) and North America who contracted COVID-19 in 2020 before SARS-CoV-2 vaccines were available. Using 93 commonly captured variables, we developed machine learning models that predicted the likelihood of death overall, as well as during 0–14, 15–30, > 30 days after COVID-19 presentation and identified the importance of predictors. XGBoost models were built in parallel using the same programming with a 60%:20%:20% random split for training, validation, & testing data for the datasets from LatAm (Argentina, Columbia, Ecuador) and North America (United States) countries. Results Among HD patients with COVID-19, 28.8% (1,001/3,473) died in LatAm and 20.5% (4,426/21,624) died in North America. Mortality occurred earlier in LatAm versus North America; 15.0% and 7.3% of patients died within 0–14 days, 7.9% and 4.6% of patients died within 15–30 days, and 5.9% and 8.6% of patients died > 30 days after COVID-19 presentation, respectively. Area under curve ranged from 0.73 to 0.83 across prediction models in both regions. Top predictors of death after COVID-19 consistently included older age, longer vintage, markers of poor nutrition and more inflammation in both regions at all timepoints. Unique patient attributes (higher BMI, male sex) were top predictors of mortality during 0–14 and 15–30 days after COVID-19, yet not mortality > 30 days after presentation. Conclusions Findings showed distinct profiles of mortality in COVID-19 in LatAm and North America throughout 2020. Mortality rate was higher within 0–14 and 15–30 days after COVID-19 in LatAm, while mortality rate was higher in North America > 30 days after presentation. Nonetheless, a remarkable proportion of HD patients died > 30 days after COVID-19 presentation in both regions. We were able to develop a series of suitable prognostic prediction models and establish the top predictors of death in COVID-19 during shorter-, intermediate-, and longer-term follow up periods.

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

et al. 2022

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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.

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Trajectories of Clinical and Laboratory Characteristics Associated with COVID-19 in Hemodialysis Patients by Survival

Cited by 3 publications

References 16 publications

Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

Predictors of shorter- and longer-term mortality after COVID-19 presentation among dialysis patients: parallel use of machine learning models in Latin and North American countries

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

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