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Fatality rate, risk factors, and functional decline in peritoneal dialysis patients with coronavirus disease 2019: A
Piyatida Chuengsaman1, Sarinya Boongird2, Phongsak Dandecha3
1Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Bangkok, Thailand.
Insights
Peritoneal dialysis patients face a high COVID-19 fatality rate, with functional impairment and the Delta variant increasing risks. Vaccination and corticosteroid therapy were associated with reduced mortality in these patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Extensive research exists on coronavirus disease 2019 (COVID-19) mortality in hemodialysis patients.
- Data regarding COVID-19 outcomes in peritoneal dialysis (PD) patients are limited.
- Understanding COVID-19's impact on PD patients is crucial for targeted interventions.
Purpose of the Study:
- To determine the 28-day COVID-19-related fatality rate in peritoneal dialysis patients.
- To identify predictors associated with mortality in PD patients diagnosed with COVID-19.
- To assess changes in functional status among PD patients during COVID-19 infection.
Main Methods:
- Nationwide cohort study utilizing the InCov19-PD registry (August 2021 - July 2022).
- Inclusion of 1,487 eligible peritoneal dialysis patients.
- Multivariable Cox regression analysis to identify mortality predictors and assess functional status changes.
Main Results:
- A 28-day COVID-19 case fatality rate of 13% (196 deaths) was observed among PD patients.
- Independent predictors of increased mortality included functional impairment, SARS-CoV-2 Delta variant infection, and need for respiratory support.
- COVID-19 vaccination and corticosteroid therapy were associated with a reduced risk of death; functional independence significantly declined during infection.
Conclusions:
- Peritoneal dialysis patients exhibit a high 28-day COVID-19 fatality rate.
- Key predictors of mortality in PD patients mirror those identified in hemodialysis populations.
- Significant functional deterioration is a common outcome for PD patients during COVID-19.
Background:
The fatality rates and factors associated with death from coronavirus disease 2019 (COVID-19) in hemodialysis patients have been extensively investigated. However, data on peritoneal dialysis (PD) patients remain scarce.
Materials And Methods:
In this nationwide cohort study, we assessed the 28-day COVID-19-related fatality rate in PD patients between August 2021 and July 2022 using data from the InCov19-PD registry. Predictors associated with death were evaluated using a multivariable Cox regression model. Changes in functional status before and during COVID-19 were also examined.
Results:
A total of 1,487 eligible participants were evaluated. During the study period, 196 participants died within 28 days after COVID-19 diagnosis (case fatality rate: 13%). In a multivariable Cox regression model, an increased risk of death within 28 days after COVID-19 diagnosis among PD patients was independently associated with functional impairment during COVID-19 [adjusted hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.59-3.81], SARS-CoV-2 infection with the Delta variant (HR 2.23, 95% CI 1.55-3.21), and the need for respiratory support (HR 7.13, 95% CI 3.74-13.57) (p < 0.01 for all). Conversely, the number of COVID-19 vaccines administered (HR 0.69, 95% CI 0.55-0.87; p = 0.001) and receiving corticosteroid therapy during COVID-19 (HR 0.72, 95% CI 0.54-0.97; p = 0.03) were associated with a decreased risk of death within 28 days after COVID-19 diagnosis. The number of functionally independent PD patients dropped from 94% at baseline to 63% during COVID-19 (p < 0.01).
Conclusions:
The COVID-19-related 28-day fatality rate was high among PD patients. The predictors of COVID-19-related death in PD patients were similar to those in hemodialysis patients. During COVID-19, PD patients commonly experienced functional deterioration.
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