Covid-19 and Mortality in Chronic Hemodialysis Patients: Cause or Mere Concomitance? The Experience of Policlinico Gemelli

Background. This study evaluated the causes of and risk factors for mortality among patients on chronic HD hospitalised with SARS-CoV-2; in particular, it evaluated whether the cause of death was directly related to coronavirus disease 2019 (Covid-19) or another pathology. The European Renal Association registry showed a 20% mortality rate after 28 days for these patients. Methods. The clinical data of chronic HD patients hospitalised because of SARS-CoV-2 at the Fondazione Policlinico Universitario Agostino Gemelli from 15 March 2020 to 28 February 2022 were analysed. Univariate and multivariate regression analyses were performed to identify risk factors for mortality. The causes of mortality were obtained from the hospital discharge forms. Results. One hundred fifty-two patients on maintenance haemodialysis with positive SARS-CoV-2 test results were hospitalised during the study period. There were 100 male (65.8%) and 52 female (34.2%) patients (mean age, 69 years; standard deviation [SD], 14.14 years). The mean Charlson comorbidity index (CCI) was 6.44 (SD, 2.64), and the average hospitalisation length was 23.57 days (SD, 24.55 days). Forty-two (27.6%) patients died, but only 22 deaths (59%) were directly caused by Covid-19. Conclusions. Only 59% of the deaths of patients with positive Covid-19 test results were directly caused by Covid-19. The survival of patients on chronic HD is independently related to specific patient characteristics (age, CCI, presence of peripheral vascular disease, and intensive care unit admission), but not to Covid-19.