Brazilian Dialysis Survey 2020.

INTRODUCTION: National data on chronic dialysis treatment are essential to support the development of health policies aimed at improving the treatment for thousands of people. OBJECTIVE: To report epidemiological data from the 2020 Brazilian Dialysis Survey, sponsored by the Brazilian Society of Nephrology. METHODS: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire for the year, covering clinical and epidemiological aspects of patients in a chronic dialysis program, data on dialysis therapy, characteristics of dialysis units and the impact of the COVID-19 pandemic. RESULTS: 235 (28%) of the centers responded to the questionnaire. In July 2020, the estimated total number of patients on dialysis was 144,779. The estimated prevalence and incidence rates of patients per million population (pmp) were 684 and 209, respectively. Of the prevalent patients, 92.6% were on hemodialysis (HD) and 7.4% were on peritoneal dialysis (PD); 23% were on the transplant waiting list. A central venous catheter was used by a quarter of patients on HD. The incidence rate of confirmed COVID-19 between February and July 2020 was 684/10,000 dialysis patients, and the lethality rate was 25.7%. The estimated overall mortality and COVID-19 crude annual mortality rates were 24.5 and 4.2%, respectively. CONCLUSION: The absolute number of patients on chronic dialysis and prevalence rate continued to increase. The low use of PD as dialysis therapy was maintained and the use of long-term catheters for HD increased. The COVID-19 pandemic contributed to the increase in the overall mortality rate.

Chronic hemodialysis patients with COVID-19 cared for by the public health system have higher mortality than those treated in private facilities: analysis of the Brazilian dialysis registry.

PURPOSE: Brazil is the third country globally in dialysis patients. Little is known about the impact of the type of health insurance on the outcome of these patients after COVID-19. METHODS: We analyzed comorbidities, sociodemographic factors, and dialysis-related parameters from a retrospective cohort study of 1866 Brazilian chronic hemodialysis patients with COVID-19 from Feb 2020-July 2021. We evaluated the influence of health insurance (private vs. public) on the intensive care unit admission and 90 day fatality risk. RESULTS: From 1866 hemodialysis patients, 455 (24%) were admitted to the intensive care unit, and 350 (19%) died. The mean age was 57.5 years, 88% had public health insurance. Crude case-fatality rate was not different between groups (private vs. public risk ratio 1.11; 95% CI 0.82-1.52, p = 0.498). In fully adjusted multivariate models, patients with private health insurance did not have a higher chance to be admitted to an intensive care unit (odds ratio 0.97; 95% CI 0.63-1.50, p = 0.888), but they presented a lower death risk (hazard ratio 0.56; 95% CI 0.37-0.85, p = 0.006). CONCLUSION: The type of health insurance did not influence the access of hemodialysis patients with COVID-19 to an intensive care unit, but patients with private health insurance had a lower mortality risk.

Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study.

BACKGROUND AND OBJECTIVES: Patients undergoing kidney replacement therapies (KRTs) have a poor prognosis after Covid-19 infection. Few studies have compared the outcomes of such patients in the different KRT modalities. This study aimed to analyze the 30-day Covid-19-associated case-fatality rate of dialysis and kidney transplant patients. METHODS: Retrospective cohort study analyzing data from patients with confirmed Covid-19 between Mar/20 and Jan/21 included in two multicenter studies, the Brazilian Covid-19 Dialysis Study (Dialysis group, n = 703) and the Covid-19-KT Brazilian Study (Transplant group, n = 1907). To assess the risk factors for death, adjusted Cox hazards models were used. A sensitivity analysis was performed using a propensity score analysis to match the groups (n = 587 patients in each group). RESULTS: A higher percentage of transplant patients required hospitalization (68 vs. 51%, p < 0.001), intensive care (37 vs. 30%, p = 0.023), and invasive mechanical ventilation (28 vs. 22%, p = 0.035). Multivariate analysis of the before-matching sample showed that subjects in the transplant group were at a lower death risk at baseline (HR 0.380.560.85). However, they showed higher risk over time (HR 1.031.061.09). Kaplan-Meier analysis after propensity score matching confirmed the inferior 30-day cumulative survival in the transplant recipients (83 vs. 78%, p = 0.0014). CONCLUSION: Both transplant and dialysis patients have high 30-day case-fatality rates after a Covid-19 diagnosis. Despite lower death risk at baseline, transplant patients have an increased death risk of 6% per day than dialysis patients.

Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study

Background and objectives Patients undergoing kidney replacement therapies (KRTs) have a poor prognosis after Covid-19 infection. Few studies have compared the outcomes of such patients in the different KRT modalities. This study aimed to analyze the 30-day Covid-19-associated case-fatality rate of dialysis and kidney transplant patients. Methods Retrospective cohort study analyzing data from patients with confirmed Covid-19 between Mar/20 and Jan/21 included in two multicenter studies, the Brazilian Covid-19 Dialysis Study (Dialysis group, n = 703) and the Covid-19-KT Brazilian Study (Transplant group, n = 1907). To assess the risk factors for death, adjusted Cox hazards models were used. A sensitivity analysis was performed using a propensity score analysis to match the groups (n = 587 patients in each group). Results A higher percentage of transplant patients required hospitalization (68 vs. 51%, p < 0.001), intensive care (37 vs. 30%, p = 0.023), and invasive mechanical ventilation (28 vs. 22%, p = 0.035). Multivariate analysis of the before-matching sample showed that subjects in the transplant group were at a lower death risk at baseline (HR 0.380.560.85). However, they showed higher risk over time (HR 1.031.061.09). Kaplan–Meier analysis after propensity score matching confirmed the inferior 30-day cumulative survival in the transplant recipients (83 vs. 78%, p = 0.0014). Conclusion Both transplant and dialysis patients have high 30-day case-fatality rates after a Covid-19 diagnosis. Despite lower death risk at baseline, transplant patients have an increased death risk of 6% per day than dialysis patients. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01172-1.

Evaluation of central venous catheter and other risk factors for mortality in chronic hemodialysis patients with COVID-19 in Brazil.

PURPOSE: Hemodialysis patients with COVID-19 are at increased risk of death. We aimed to describe the characteristics of a cohort of Brazilian hemodialysis patients with COVID-19 and assess their mortality rate and risk factors for death. METHODS: Retrospective cohort study of 741 Brazilian hemodialysis patients with confirmed COVID-19 from Feb-Dec/2020, of 52 dialysis centers of the country. We analyzed comorbid conditions, sociodemographic factors, and dialysis-related parameters. To detect risk factors for mortality in hemodialysis patients, we performed multivariable Cox proportional hazard regression analysis. Survival was analyzed by Kaplan-Meier. RESULTS: From 9877 hemodialysis patients, 741 were diagnosed with COVID-19. Mean age was 57 ± 16 years, 61% were male, and 51% white. The most frequent symptoms were fever (54.1%), cough (50.9%), and dyspnea (37.2%); 14.2% were asymptomatic. There were 139 deaths (18.8%), with 66% within the disease's first 15 days. 333 patients (44.9%) required hospitalization, and 211 (28.5%) were admitted to an intensive care unit. The cumulative probability of survival at 90 days of diagnosis was 79% (95% CI 76-82%). In the fully adjusted multivariate model, the risk factors significantly associated with death were diabetes mellitus (HR 1.52, 95% CI 1.05-2.19, P = 0.026), use of a central venous catheter (CVC) (HR 1.79, 95% CI 1.22-2.64, P = 0.003), age (HR 1.03, 95% CI 1.01-1.04, P < 0.001), and origin from the North vs. Southeast region (HR 2.60, 95% CI 1.01-6.68, P = 0.047). CONCLUSIONS: Hemodialysis patients using a CVC as the vascular access, aside from diabetic and elderly ones, should be closely monitored due to their high risk of death in the course of the COVID-19.