The changing pattern of COVID-19 infection in hemodialysis and peritoneal dialysis patients

Following the first wave of COVID-19 there have been several variants. We wished to review the number and severity of infections with the different variants in a population of hemodialysis (HD) and peritoneal dialysis (PD) patients.

We reviewed the outcomes and results in HD and PD patients testing positive for COVID-19 between March 2020 and August 2022.

Seven hundred and ninety-five cases of COVID-19 were recorded in 710 dialysis patients. More HD patients than PD contracted wild type (21.4% vs. 6.8%), delta (23.3% vs 6.3%), and omicron (27.7% vs. 14.7%), all p < 0.01, but no difference with alpha (4.6% vs. 6.3%) or beta variants (5.7% vs. 6.85%). Hospitalization and death were greatest for alpha followed by wild type, beta, delta, and omicron (60.6% vs. 57% vs. 47.5% vs. 21.2% vs. 19.3%), respectively, p < 0.001. C reactive protein progressively increased from outpatient management to hospitalization to hospitalization with critical care or death (14 (4-30) vs. 41 (18-101) vs. 94 (47-168) mg/L, p < 0.001. Despite previous infection and vaccination 85 (12%) patients had two or more infections with COVID-19.

Disease severity declined and survival improved as the virus mutated from wild-type and alpha to beta, delta, and omicron variants. Whether this related to reduction in viral virulence, vaccination, natural acquired immunity, or introduction of pharmacological treatments remains to be determined. Government lockdowns and enhanced infection control measures reduced the percentage of HD patients contracting alpha and beta variants to that of PD. Vaccination and prior infection did not prevent reinfection.