Abstract
Rationale & objective: During the coronavirus disease 2019 (COVID-19) pandemic, patients receiving maintenance dialysis are a highly vulnerable population due to their comorbidities and circumstances that limit physical distancing during treatment. This study sought to characterize the risk factors for and outcomes following COVID-19 in this population.
Study design: Retrospective cohort study.
Setting & participants: Maintenance dialysis patients in clinics of a midsize national dialysis provider that had at least 1 patient who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from February to June 2020.
Predictors: Demographics, dialysis characteristics, residence in a congregated setting, comorbid conditions, measurements of frailty, and use of selected medications.
Outcomes: COVID-19, defined as having a positive SARS-CoV-2 test result, and all-cause mortality among those with COVID-19.
Analytical approach: Logistic regression analyses conducted to identify clinical characteristics associated with COVID-19 and risk factors associated with mortality among patients following COVID-19.
Results: 438 of 7948 (5.5%) maintenance dialysis patients developed COVID-19. Male sex, Black race, in-center dialysis (vs home dialysis), treatment at an urban clinic, residence in a congregate setting, and greater comorbidity were associated with contracting COVID-19. Odds of COVID-19 were 17-fold higher for those residing in a congregated setting (odds ratio [OR], 17.10 [95% CI, 13.51-21.54]). Of the 438 maintenance dialysis patients with COVID-19, 109 (24.9%) died. Older age, heart disease, and markers of frailty were associated with mortality.
Limitations: No distinction was detected between symptomatic and asymptomatic SARS-CoV-2 positivity, with asymptomatic screening limited by testing capacity during this initial COVID-19 surge period.
Conclusions: COVID-19 is common among patients receiving maintenance dialysis, particularly those residing in congregate settings. Among maintenance dialysis patients with COVID-19, mortality is high, exceeding 20%.
Keywords: coronavirus disease 2019 (COVID-19); death; dialysis; dialysis clinic; end-stage kidney disease (ESKD); end-stage renal disease (ESRD); epidemiology; mortality; nursing home; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
【저자키워드】 Mortality, Epidemiology, nursing home, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., dialysis, Coronavirus disease 2019 (COVID-19), death, End-stage renal disease (ESRD), dialysis clinic, end-stage kidney disease (ESKD), 【초록키워드】 COVID-19, Treatment, coronavirus disease, SARS-CoV-2, Coronavirus disease 2019, coronavirus, pandemic, Risk factors, Clinical characteristics, nursing home, frailty, Comorbidity, Sex, outcome, medications, risk factor, severe acute respiratory syndrome Coronavirus, dialysis, cohort study, clinics, Characteristics, Asymptomatic, Patient, Older age, End-stage renal disease, Kidney disease, age, physical distancing, renal disease, disease, ESRD, marker, Male sex, Odds ratio, heart disease, demographics, maintenance, test result, vulnerable population, during treatment, retrospective cohort study, acute respiratory syndrome, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, Black race, all-cause mortality, rationale, SARS-CoV-2 positivity, center, residence, comorbid conditions, National, Logistic regression analyses, positive, SARS-CoV-2 test, limit, setting, initial, greater, selected, defined, tested, identify, died, conducted, receiving, Logistic regression analysis, patients with COVID-19, symptomatic and asymptomatic, with COVID-19, 【제목키워드】 COVID-19, Factor,