Patients With ESKD Are Commonly Hospitalized Early During COVID-19 Illness: An Opportunity for Early Intervention

ABSTRACT

Background: Antiviral medications such as remdesivir, molnupiravir, and nirmatrelvir/ritonavir are most effective when used early in the course of COVID-19. These medications are authorized for patients with COVID-19 with mild symptoms who are at high risk for severe disease. ESKD is among the strongest risk factors for mortality from COVID-19. As the ESKD population is highly linked to care, we hypothesized that they are more likely to be admitted to the hospital within five days of symptom onset when antiviral medications are maximally effective. Method(s) We identified patients with ESKD on dialysis who were admitted to Massachusetts General Hospital with COVID-19 by using dialysis records and manually extracted the date of symptom onset as shown in the admission note. Primary outcome was the proportion of patients with ESKD admitted within 5 days of symptom onset;secondary outcome was the risk of respiratory failure within 90 days among the early presenters. Result(s) After implementing the exclusion criteria shown in Figure 1, we included 99 patients with community-acquired COVID-19 admitted between March 2020 and Jan 2022. Thirty patients (30%) remained asymptomatic during their hospitalization. Among patients with symptomatic COVID-19, 56 (81%) were admitted within 5 days of symptom onset;among them, 17 developed respiratory failure within 90 days (30%) and 11 died from respiratory failure (20%). (Figure1) Conclusion(s) We found that most patients with ESKD on dialysis admitted for symptomatic COVID-19 presented within 5 days of symptom onset. We conjectured that because of this, inpatient antiviral therapy may be more effective in the ESKD population than in a typical inpatient population with COVID-19 that presents later in the disease course. Given the high risk of respiratory failure in ESKD population who developed COVID-19, improved treatment strategies are urgently needed.