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Survival study and factors associated with mortality in Chilean patients on peritoneal dialysis infected with
Ana M Ortiz1,2, Rodrigo A Sepúlveda1, Rubén Torres2
1Department of Nephrology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile.
Insights
Patients on peritoneal dialysis (PD) face high mortality from Covid-19. Key risk factors include older age, diabetes, and longer PD duration, necessitating enhanced infection control strategies.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- The Covid-19 pandemic significantly increased mortality globally.
- Patients with comorbidities, particularly those on peritoneal dialysis (PD), exhibit higher morbidity and mortality rates.
- Understanding Covid-19's impact on PD patients is crucial for public health strategies.
Purpose of the Study:
- To prospectively evaluate the outcomes of Covid-19 infection in patients undergoing peritoneal dialysis in Chile.
- To identify demographic, comorbidity, and infection-related factors associated with hospitalization and mortality in this vulnerable population.
- To inform preventative measures and clinical management for Covid-19 in PD patients.
Main Methods:
- Prospective cohort study of all Chilean patients on PD across 48 centers.
- Data collection from March 2020 to January 2021, focusing on SARS-CoV-2 infected individuals.
- Analysis of demographic data, comorbidities, infection sources, hospitalization rates, and mortality due to Covid-19.
Main Results:
- 106 adult PD patients were infected with SARS-CoV-2; 53.9% were female, mean age 53.1 years.
- 54.8% required hospitalization, and 24.5% (26 patients) died from Covid-19.
- Significant mortality predictors included age ≥60, diabetes, PD duration ≥5 years, hospitalization, and hospital-acquired infections.
Conclusions:
- Peritoneal dialysis patients without Covid-19 vaccination face substantial risks of hospitalization and mortality.
- Intensified infection prevention strategies are essential, particularly for elderly patients, those with diabetes, and individuals on PD for over five years.
- Early identification and management of Covid-19 in PD patients are critical to mitigate severe outcomes.
Abstract:
The Covid-19 pandemic has been responsible for millions of deaths worldwide. Patients with comorbidities- such as those on peritoneal dialysis (PD)- present higher morbidity and mortality than the general population. We prospectively evaluated all Chilean patients on PD (48 centres) and followed those who had Covid-19 from the beginning of the Covid-19 pandemic in Chile (March 2020) to January 2021 (start of vaccination campaign). We described demographic history, comorbidities, factors related to infection, need for hospitalisation and death due to Covid-19. During the study period, 106 adults on PD were infected by SARS-CoV-2, with a mean age of 53.1 (±16.3) and of which 53.9% were female. From that group, 54.8% required hospitalisation and 24.5% (n = 26) died due to Covid-19. Most of the patients (63.4%) were infected at home and 22.8% during hospitalisation for other reasons. There was a significant association for Covid-19 mortality with: being ≥60 years old, diabetes, time on PD ≥5 years, need for hospitalisation and hospital-acquired infection. At 90 days of follow-up, all deaths associated to Covid-19 occurred before 40 days. We conclude that patients on PD without Covid-19 vaccination have a high mortality and need for hospitalisation associated to Covid-19. To avoid this negative outcome, it is necessary to intensify strategies to avoid contagion, especially in those ≥60 years old, with diabetes and/or ≥5 years spent on PD.
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