CLINICAL OUTCOMES OF IN-CENTER HEMODIALYSIS PATIENTS DURING THE COVID-19 PANDEMIC

ABSTRACT

At Dialysis Clinic Inc., a national dialysis provider, we assessed the impact of COVID-19 on delivery of care by comparing the risk of mortality and hospitalization month-over-month over three years. Monthly rates for all-cause mortality (with Poisson regression) and hospitalization (with negative binomial regression) were calculated per 1000 patient months for in-center hemodialysis (ICHD) patients for calendar months Jan-Sept for 2018, 2019 and 2020, adjusted for age and race. The analysis was repeated with and without patients with COVID-19. During Jan-Sept 2020 there were 1,743 deaths in 15,336 non-COVID-19 patients and 204 deaths in 995 COVID-19 patients. A nonsignificant increased monthly mortality rate was observed in April 2020 [15.79 (13.83, 18.02)] relative to other months in 2018, 2019 and 2020 (Figure). Excluding patients after COVID-19 diagnosis, the April 2020 monthly death rate decreased [12.16 (10.45, 14.15)] in alignment with other months/years. During Jan-Sept 2020 there were 14,531 hospitalizations in 15,336 non-COVID-19 patients and 976 hospitalizations in 995 COVID-19 patients. There was a significant decrease in monthly hospitalization rate in April 2020 [111.39 (105.08, 118.08)] (Figure) and a further significant decrease after excluding COVID-19 patients [98.07 (92.15, 104.38)] relative to other months in 2018, 2019, and 2020. During the COVID-19 pandemic ICHD patient monthly mortality rates did not differ significantly whereas hospitalization rates did decrease significantly during the month of April 2020 Despite lower hospitalization rates, outpatient care quality was sufficiently maintained to avoid increased non-COVID marginal mortality risk.