tetano
Editor, Senior Moderator
Clin Kidney J
. 2021 Dec 20;15(3):432-441.
doi: 10.1093/ckj/sfab248. eCollection 2022 Mar.
Increased 1-year mortality in haemodialysis patients with COVID-19: a prospective, observational study
Sol Carriazo[SUP] 1 [/SUP], Sebastian Mas-Fontao[SUP] 2 [/SUP], Clara Seghers[SUP] 1 [/SUP], Jaime Cano[SUP] 1 [/SUP], Elena Goma[SUP] 1 [/SUP], Alejandro Avello[SUP] 1 [/SUP], Alberto Ortiz[SUP] 1 [/SUP], Emilio Gonzalez-Parra[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Dialysis confers the highest risk of coronavirus disease 2019 (COVID-19) death among comorbidities predisposing to severe COVID-19. However, reports of COVID-19-associated mortality frequently refer to mortality during the initial hospitalization or first month after diagnosis.
Methods: In a prospective, observational study, we analysed the long-term (1-year follow-up) serological and clinical outcomes of 56 haemodialysis (HD) patients who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first pandemic wave. COVID-19 was diagnosed by a positive polymerase chain reaction (PCR) test (n = 37) or by the development of anti-SARS-CoV-2 antibodies (n = 19).
Results: After >1 year of follow-up, 35.7% of HD patients infected by SARS-CoV-2 during the first pandemic wave had died, 6 (11%) during the initial admission and 14 (25%) in the following months, mainly within the first 3 months after diagnosis. Overall, 30% of patients died from vascular causes and 40% from respiratory causes. In adjusted analysis, a positive SARS-CoV-2 PCR test for diagnosis {hazard ratio
5.18 [interquartile range (IQR) 1.30-20.65], P = 0.020}, higher baseline C-reactive protein levels [HR 1.10 (IQR 1.03-1.16), P = 0.002] and lower haemoglobin levels [HR 0.62 (IQR 0.45-0.86), P = 0.005] were associated with higher 1-year mortality. Mortality in the 144 patients who did not have COVID-19 was 21 (14.6%) over 12 months [HR of death for COVID-19 patients 3.00 (IQR 1.62-5.53), log-rank P = 0.00023]. Over the first year, the percentage of patients having anti-SARS-CoV-2 immunoglobulin G (IgG) decreased from 36/49 (73.4%) initially to 27/44 (61.3%) at 6 months and 14/36 (38.8%) at 12 months.
Conclusions: The high mortality of HD patients with COVID-19 is not limited to the initial hospitalization. Defining COVID-19 deaths as those occurring within 3 months of a COVID-19 diagnosis may better represent the burden of COVID-19. In HD patients, the anti-SARS-CoV-2 IgG response was suboptimal and short-lived.
Keywords: COVID-19; anti-SARS-CoV-2 antibodies; chronic kidney disease; haemodialysis; mortality; outcomes.
. 2021 Dec 20;15(3):432-441.
doi: 10.1093/ckj/sfab248. eCollection 2022 Mar.
Increased 1-year mortality in haemodialysis patients with COVID-19: a prospective, observational study
Sol Carriazo[SUP] 1 [/SUP], Sebastian Mas-Fontao[SUP] 2 [/SUP], Clara Seghers[SUP] 1 [/SUP], Jaime Cano[SUP] 1 [/SUP], Elena Goma[SUP] 1 [/SUP], Alejandro Avello[SUP] 1 [/SUP], Alberto Ortiz[SUP] 1 [/SUP], Emilio Gonzalez-Parra[SUP] 1 [/SUP]
Affiliations
- PMID: 35198156
- PMCID: PMC8755355
- DOI: 10.1093/ckj/sfab248
Abstract
Background: Dialysis confers the highest risk of coronavirus disease 2019 (COVID-19) death among comorbidities predisposing to severe COVID-19. However, reports of COVID-19-associated mortality frequently refer to mortality during the initial hospitalization or first month after diagnosis.
Methods: In a prospective, observational study, we analysed the long-term (1-year follow-up) serological and clinical outcomes of 56 haemodialysis (HD) patients who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first pandemic wave. COVID-19 was diagnosed by a positive polymerase chain reaction (PCR) test (n = 37) or by the development of anti-SARS-CoV-2 antibodies (n = 19).
Results: After >1 year of follow-up, 35.7% of HD patients infected by SARS-CoV-2 during the first pandemic wave had died, 6 (11%) during the initial admission and 14 (25%) in the following months, mainly within the first 3 months after diagnosis. Overall, 30% of patients died from vascular causes and 40% from respiratory causes. In adjusted analysis, a positive SARS-CoV-2 PCR test for diagnosis {hazard ratio
5.18 [interquartile range (IQR) 1.30-20.65], P = 0.020}, higher baseline C-reactive protein levels [HR 1.10 (IQR 1.03-1.16), P = 0.002] and lower haemoglobin levels [HR 0.62 (IQR 0.45-0.86), P = 0.005] were associated with higher 1-year mortality. Mortality in the 144 patients who did not have COVID-19 was 21 (14.6%) over 12 months [HR of death for COVID-19 patients 3.00 (IQR 1.62-5.53), log-rank P = 0.00023]. Over the first year, the percentage of patients having anti-SARS-CoV-2 immunoglobulin G (IgG) decreased from 36/49 (73.4%) initially to 27/44 (61.3%) at 6 months and 14/36 (38.8%) at 12 months.
Conclusions: The high mortality of HD patients with COVID-19 is not limited to the initial hospitalization. Defining COVID-19 deaths as those occurring within 3 months of a COVID-19 diagnosis may better represent the burden of COVID-19. In HD patients, the anti-SARS-CoV-2 IgG response was suboptimal and short-lived.
Keywords: COVID-19; anti-SARS-CoV-2 antibodies; chronic kidney disease; haemodialysis; mortality; outcomes.