Mortality in an emergency-only hemodialysis population from COVID-19 in a large safety net

ABSTRACT

Background: The COVID-19 pandemic has shown to disproportionately impact certain populations highlighting health, economic and social disparities. An especially vulnerable group is the emergency-only hemodialysis (EoHD) patient population at Grady Health System, 91% of whom are Hispanic with a median age of 52. This population initially included 102 EoHD patients followed from 4/2020 to 5/2021. A COVID screening protocol was developed to assess disease prevalence, and patients who tested positive were isolated and treated accordingly. The aim of this study is to estimate the mortality rate in this at-risk population. Methods: From 4/2020 to 5/2021, COVID PCR tests were administered either as scheduled screenings or diagnostically if a patient presented with symptoms;patients testing positive were isolated per health department and hospital policy recommendations. In total 494 PCR tests were performed, and 444 were screening;each patient received an average of 4.8 tests. Hospital admissions, complications, and mortality data were collected and analyzed using statistical software. Results: A total of 102 patients comprised the EoHD cohort at the onset of the study in 4/2020. Of this population, 58 (58%) patients tested positive for COVID and 19 (33%) of these COVID cases required hospitalization. The majority of positive cases (n = 32, 55%) were in asymptomatic patients and detected with screening tests while the remaining were diagnostic results. Eleven (11%) patient deaths occurred during the study, and two (2%) were attributed to COVID related complications. The remaining causes of death included hemorrhagic shock (1), cardiac arrest (1), heart failure (2), and unspecified, non-COVID related illnesses (5). The prevalence of COVID infection in patients who had diabetes and/or hypertension was non-significant (p-value = 0.2). Conclusions: Amongst the EoHD population, the risk of COVID-19 is disproportionately high compared to the general population possibly due to chronic exposure to healthcare settings and socioeconomic disadvantages. One would expect the mortality from COVID to be higher in this cohort as compared to the general population due to ESRD and associated comorbid conditions. However, our results show that COVID attributable deaths in the EoHD population was 2%, which is comparable to the 1.8% mortality rate observed in the general U.S. population.