Patients on chronic maintenance hemodialysis with and without COVID-19 infection: Comparison of baseline characteristics and mortality

ABSTRACT

Background: The COVID-19 pandemic has impacted nearly all aspects of the care of patients, particularly those with chronic conditions. There is a need for higher quality of evidence to better identify populations at risk, in various clinical situations. We analyzed the difference in demographic characteristics in patients with end stage kidney disease (ESKD) who were started on hemodialysis (HD) in 2020 and contracted COVID-19, with those who remained free of the infection in a large multicenter cohort. Methods: We performed a retrospective multi-center cohort study using TriNetX Research Network database, a federate medical records network, to identify 7405 unique adult patients ≥ 18 years from 37 healthcare organizations (HCOs), mostly in the United States, for whom maintenance HD was initiated for ESKD between 1/1/2020 and 12/31/2020 (study period). From this group, we then identified patients who had a confirmed diagnosis of COVID-19 infection during the study period. We calculated the odds ratio (OR) and 95% confidence interval (CI) of mortality in the first three months of initiation of HD for the COVID group. Results: 903 patients (from 33 HCOs) had a confirmed diagnosis of COVID-19 infection. Patients in the COVID-positive group were less likely to be white (p=0.019), and more likely to -be of Hispanic/Latino ethnicity (p<0.0001), -have had a previously failed kidney transplant (p<0.0001) -have diabetes mellitus (DM) (<0.0001), and -have a BMI above 31 (p=0.003). A total of 628 patients died during the study period. After propensity matching, COVID exposure was associated with higher odds of mortality (OR 2.32;CI 11.66, 3.24). The survival probability at the end of 3 months was 84.4% for the COVID group, compared with 92.5% for the no-COVID group (p<0.0001). Conclusions: During the study period, among the patients who were started on HD for ESKD, those who contracted COVID-19 infection were more likely to be Hispanic/ Latino, less likely to be white, more likely to have a previously failed kidney transplant, more likely to have DM, and to have a BMI above 31. The COVID-positive group also had a higher mortality and a lesser 3-month survival probability compared to the control group.