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Mortality and associated risk factors of COVID-19 infection in dialysis patients in Qatar: A nationwide cohort study.
Ghonimi, Tarek Abdel Latif; Alkad, Mohamad Mahmood; Abuhelaiqa, Essa Abdulla; Othman, Muftah M; Elgaali, Musab Ahmed; Ibrahim, Rania Abdelaziz M; Joseph, Shajahan M; Al-Malki, Hassan Ali; Hamad, Abdullah Ibrahim.
  • Ghonimi TAL; Hamad Medical Corporation, Doha, Qatar.
  • Alkad MM; Hamad Medical Corporation, Doha, Qatar.
  • Abuhelaiqa EA; Hamad Medical Corporation, Doha, Qatar.
  • Othman MM; Hamad Medical Corporation, Doha, Qatar.
  • Elgaali MA; Hamad Medical Corporation, Doha, Qatar.
  • Ibrahim RAM; Hamad Medical Corporation, Doha, Qatar.
  • Joseph SM; Hamad Medical Corporation, Doha, Qatar.
  • Al-Malki HA; Hamad Medical Corporation, Doha, Qatar.
  • Hamad AI; Hamad Medical Corporation, Doha, Qatar.
PLoS One ; 16(7): e0254246, 2021.
Article in English | MEDLINE | ID: covidwho-1320544
ABSTRACT
CONTEXT Patients on maintenance dialysis are more susceptible to COVID-19 and its severe form. We studied the mortality and associated risks of COVID-19 infection in dialysis patients in the state of Qatar.

METHODS:

This was an observational, analytical, retrospective, nationwide study. We included all adult patients on maintenance dialysis therapy who tested positive for COVID-19 (PCR assay of the nasopharyngeal swab) during the period from February 1, 2020, to July 19, 2020. Our primary outcome was to study the mortality of COVID-19 in dialysis patients in Qatar and risk factors associated with it. Our secondary objectives were to study incidence and severity of COVID-19 in dialysis patients and comparing outcomes between hemodialysis and peritoneal dialysis patients. Patient demographics and clinical features were collected from a national electronic medical record. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort.

RESULTS:

76 out of 1064 dialysis patients were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). During the study period, 7.1% of all dialysis patients contracted COVID-19. Male dialysis patients had double the incidence of COVID-19 than females (9% versus 4.5% respectively; p<0.01). The most common symptoms on presentation were fever (57.9%), cough (56.6%), and shortness of breath (25%). Pneumonia was diagnosed in 72% of dialysis patients with COVID-19. High severity manifested as 25% of patients requiring admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes. The mean length of hospital stay was 19.2 ± -12 days. Mortality due to COVID-19 among our dialysis cohort was 15%. Univariate Cox regression analysis for risk factors associated with COVID-19-related death in dialysis patients showed significant increases in risks with age (OR 1.077, CI 95%(1.018-1.139), p = 0.01), CHF and COPD (both same OR 8.974, CI 95% (1.039-77.5), p = 0.046), history of DVT (OR 5.762, CI 95% (1.227-27.057), p = 0.026), Atrial fibrillation (OR 7.285, CI 95%(2.029-26.150), p = 0.002), hypoxia (OR 16.6; CI 95%(3.574-77.715), p = <0.001), ICU admission (HR30.8, CI 95% (3.9-241.2), p = 0.001), Mechanical ventilation (HR 50.07 CI 95% (6.4-391.2)), p<0.001) and using inotropes(HR 19.17, CI 95% (11.57-718.5), p<0.001). In a multivariate analysis, only ICU admission was found to be significantly associated with death [OR = 32.8 (3.5-305.4), p = 0.002)].

CONCLUSION:

This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high incidence of COVID-19 infection and related mortality compared to previous reports of the general population in the state of Qatar (7.1% versus 4% and 15% versus 0.15% respectively). We also observed a strong association between death related to COVID-19 infection in dialysis patients and admission to ICU.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Renal Dialysis / COVID-19 Type of study: Etiology study / Incidence study / Observational study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0254246

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Renal Dialysis / COVID-19 Type of study: Etiology study / Incidence study / Observational study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0254246