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Published on: October 2, 2020
Increased 1-year mortality in haemodialysis patients with COVID-19: a prospective, observational study
Sol Carriazo1, Sebastian Mas-Fontao2, Clara Seghers1
1Servicio de Nefrología e Hipertensión, Fundación Jiménez Díaz, IIS-FJD UAM, Madrid, Spain.
Insights
Long-term mortality in hemodialysis patients with COVID-19 remains high, extending beyond initial hospitalization. This study highlights the significant burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this vulnerable population.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Patients undergoing hemodialysis (HD) face the highest risk of death from coronavirus disease 2019 (COVID-19).
- Existing mortality reports often focus on short-term outcomes during initial hospitalization or the first month post-diagnosis.
Purpose of the Study:
- To evaluate the long-term (1-year) serological and clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
- To assess the true mortality burden of COVID-19 in HD patients beyond the initial diagnosis period.
Main Methods:
- A prospective, observational study followed 56 hemodialysis patients infected with SARS-CoV-2 during the first pandemic wave.
- COVID-19 diagnosis was confirmed via positive PCR test or development of anti-SARS-CoV-2 antibodies.
- Long-term outcomes included mortality, serological response (anti-SARS-CoV-2 IgG), and clinical factors over a 1-year follow-up period.
Main Results:
- After 1 year, 35.7% of infected HD patients died, with a significant portion occurring months after diagnosis.
- Vascular (30%) and respiratory (40%) causes predominated among deaths.
- Positive SARS-CoV-2 PCR, higher C-reactive protein, and lower hemoglobin levels were associated with increased 1-year mortality.
- Mortality in non-COVID-19 HD patients was 14.6%, significantly lower than in COVID-19 patients (3.00 HR).
- Anti-SARS-CoV-2 IgG levels decreased significantly over 12 months, indicating a suboptimal and short-lived immune response.
Conclusions:
- The high mortality associated with COVID-19 in hemodialysis patients extends well beyond the initial hospitalization period.
- Defining COVID-19 deaths within 3 months of diagnosis may provide a more accurate representation of the disease's impact in this population.
- Hemodialysis patients exhibit a suboptimal and transient anti-SARS-CoV-2 IgG antibody response, potentially contributing to prolonged vulnerability.
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 [HR] 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.
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