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COVID-19 Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider.
Hsu, Caroline M; Weiner, Daniel E; Aweh, Gideon; Miskulin, Dana C; Manley, Harold J; Stewart, Carol; Ladik, Vlad; Hosford, John; Lacson, Edward C; Johnson, Douglas S; Lacson, Eduardo.
  • Hsu CM; Nephrology Division, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA.
  • Weiner DE; Nephrology Division, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA.
  • Aweh G; Dialysis Clinic, Inc., Nashville, TN.
  • Miskulin DC; Nephrology Division, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA.
  • Manley HJ; Dialysis Clinic, Inc., Nashville, TN.
  • Stewart C; Dialysis Clinic, Inc., Nashville, TN.
  • Ladik V; Dialysis Clinic, Inc., Nashville, TN.
  • Hosford J; Dialysis Clinic, Inc., Nashville, TN.
  • Lacson EC; Dialysis Clinic, Inc., Nashville, TN.
  • Johnson DS; Dialysis Clinic, Inc., Nashville, TN.
  • Lacson E; Nephrology Division, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA; Dialysis Clinic, Inc., Nashville, TN. Electronic address: Eduardo.lacson@dciinc.org.
Am J Kidney Dis ; 77(5): 748-756.e1, 2021 05.
Article in English | MEDLINE | ID: covidwho-1152906
ABSTRACT
RATIONALE &

OBJECTIVE:

During the coronavirus disease 2019 (COVID-19) pandemic, patients receiving maintenance dialysis are a highly vulnerable population due to their comorbidities and circumstances that limit physical distancing during treatment. This study sought to characterize the risk factors for and outcomes following COVID-19 in this population. STUDY

DESIGN:

Retrospective cohort study. SETTING &

PARTICIPANTS:

Maintenance dialysis patients in clinics of a midsize national dialysis provider that had at least 1 patient who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from February to June 2020. PREDICTORS Demographics, dialysis characteristics, residence in a congregated setting, comorbid conditions, measurements of frailty, and use of selected medications.

OUTCOMES:

COVID-19, defined as having a positive SARS-CoV-2 test result, and all-cause mortality among those with COVID-19. ANALYTICAL

APPROACH:

Logistic regression analyses conducted to identify clinical characteristics associated with COVID-19 and risk factors associated with mortality among patients following COVID-19.

RESULTS:

438 of 7948 (5.5%) maintenance dialysis patients developed COVID-19. Male sex, Black race, in-center dialysis (vs home dialysis), treatment at an urban clinic, residence in a congregate setting, and greater comorbidity were associated with contracting COVID-19. Odds of COVID-19 were 17-fold higher for those residing in a congregated setting (odds ratio [OR], 17.10 [95% CI, 13.51-21.54]). Of the 438 maintenance dialysis patients with COVID-19, 109 (24.9%) died. Older age, heart disease, and markers of frailty were associated with mortality.

LIMITATIONS:

No distinction was detected between symptomatic and asymptomatic SARS-CoV-2 positivity, with asymptomatic screening limited by testing capacity during this initial COVID-19 surge period.

CONCLUSIONS:

COVID-19 is common among patients receiving maintenance dialysis, particularly those residing in congregate settings. Among maintenance dialysis patients with COVID-19, mortality is high, exceeding 20%.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Renal Dialysis / Infection Control / Frailty / COVID-19 / Heart Diseases / Kidney Failure, Chronic Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Am J Kidney Dis Year: 2021 Document Type: Article Affiliation country: J.ajkd.2021.01.003

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Renal Dialysis / Infection Control / Frailty / COVID-19 / Heart Diseases / Kidney Failure, Chronic Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Am J Kidney Dis Year: 2021 Document Type: Article Affiliation country: J.ajkd.2021.01.003