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COVID-19 Outbreak in a Hemodialysis Center: A Retrospective Monocentric Case Series
Lionel Mazzoleni1, Chadi Ghafari2, Fabienne Mestrez1
1Department of Nephrology, Centre Hospitalier Universitaire et Psychiatrique de Mons-Borinage, Belgium.
Insights
COVID-19 significantly impacts kidney replacement therapy patients, with high mortality rates. Advanced age and cardiovascular disease increase death risk, necessitating proactive prevention in dialysis centers.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- COVID-19 poses a significant threat to patients undergoing kidney replacement therapy (KRT).
- The full impact of COVID-19 on hemodialysis centers, patients, and healthcare workers remains unclear.
Purpose of the Study:
- To analyze a COVID-19 outbreak in a Belgian hemodialysis center.
- To report the incidence, clinical course, and outcomes of COVID-19 in this patient population.
Main Methods:
- Retrospective cross-sectional cohort study of 62 hemodialysis patients and 26 healthcare workers.
- Analysis included incidence, clinical course, outcomes, and comparison between survivors/non-survivors and hospitalized/non-hospitalized patients.
- Statistical analysis used Fisher exact test, chi-squared test, Mann-Whitney rank sum test, univariate analysis, and logistic regression.
Main Results:
- High incidence of severe acute respiratory syndrome beta coronavirus 2 (SARS-CoV-2) infection: 65% in patients and 69% in healthcare workers.
- COVID-19 patients had a 28% mortality rate, with advanced age, cardiovascular disease (CVD), and obstructive sleep apnea syndrome as significant predictors of death.
- Healthcare workers experienced high infection rates but low hospitalization rates and no reported deaths.
Conclusions:
- Patients on KRT exhibit a high COVID-19 mortality rate.
- Advanced age and CVD are critical factors influencing survival in these patients.
- Urgent implementation of preventive measures is crucial to curb viral spread in dialysis facilities.
Background:
The rapid worldwide spread of COVID-19 has posed a serious threat to patients treated with kidney replacement therapy (KRT). Moreover, the impact of the disease on hemodialysis centers, the patients, and the health care workers is still not completely understood.
Objective:
We present the analysis of a COVID-19 outbreak in a hemodialysis center in Belgium and report the incidence, clinical course, and outcome of the disease.
Design:
A retrospective cross-sectional cohort study.
Setting:
A hemodialysis center during the COVID-19 outbreak.
Patients:
A total of 62 patients on maintenance hemodialysis at a tertiary care center in Belgium attended by 26 health care workers.
Measurements:
Baseline patients' characteristics were retrieved. The incidence, clinical course, and outcome were reported. The differences between COVID-19 survivors and nonsurvivors were assessed along with the differences between COVID-19-hospitalized and nonhospitalized patients. The incidence of the disease and outcome of health care workers were also reported.
Methods:
Proportions for categorical variables were compared using the Fisher exact test and χ2. The Mann-Whitney rank sum test was used to compare continuous variables. Univariate analysis and a binomial logistic regression were used to explore variables as predictors of death.
Results:
Between March 6 and April 14, 2020, 40 of 62 (65%) patients tested positive for severe acute respiratory syndrome beta coronavirus 2 (SARS-CoV-2) along with 18 of 26 (69%) health care professionals. Twenty-five (63%) of the infected patients were hospitalized with a median time for hospitalization-to-discharge of 8 (interquartile range [IQR] = 4-12) days. Eleven (28%) COVID-19-related deaths were recorded with a median time for onset of symptoms-to-death of 9 (IQR = 5-14) days. Lymphocytopenia was prevalent among the cohort and was found in 9 of 11 (82%) reported deaths (P = .4). There was no influence of the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on COVID-19-related deaths (P = .3). Advanced age, cardiovascular disease (CVD), and obstructive sleep apnea syndrome were all found to be significantly related to death. Of the 18 infected health care professionals, 13 (72%) were symptomatic and 2 (11%) were hospitalized. There was no reported death among the health care workers.
Limitations:
Limited follow-up time compared with the course of the disease along with a small sample size.
Conclusions:
Patients treated with KRT show a high mortality rate secondary to COVID-19. CVD and age are shown to impact survival. Proactive measures must be taken to prevent the spread of the virus in such facilities.
Trial Registration:
Not applicable as this is a retrospective study.
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