Clinical outcomes of COVID-19 in patients undergoing chronic hemodialysis and peritoneal dialysis

Abstract

Background: The reported incidence and fatality rate of the severe acute respiratory syndrome coronavirus 2 in patients receiving chronic dialysis are higher than in the general population. We sought to study the outcomes following coronavirus disease 2019 (COVID-19) diagnosis in patients undergoing chronic hemodialysis (HD) or peritoneal dialysis (PD) in a single center in Brazil. Methods: Of the 522 patients on dialysis evaluated between March 1, 2020, and October 1, 2021, those presenting symptoms or with a history of close contact with COVID-19 patients were tested with reverse-transcription polymerase chain reaction of samples from nasopharyngeal swabs. Results: Of the 522 patients, 120 were positive for COVID-19 infection, of which 86% were on HD and 14% in the PD program. The incidence per 10,000 inhabitants was higher in the HD group than in the PD group (2,423.5 vs. 1,752.5). The mortality per 10,000 inhabitants (470.5 vs. 927.8) and the fatality rate (19.4 vs. 52.9%, p = 0.005) were higher in the PD group. The PD group also had a higher need for hospitalization, intensive care, and mechanical ventilation. Conclusions: We advise caution when considering strategies to transfer patients from HD to the PD program to minimize the risk of COVID-19 for patients on HD.

Viver é muito perigoso: dialisando na pandemia

“…O estudo de Gorayeb-Polacchini et al 4 nos auxilia a entender como se configura a pandemia nos pacientes em programa brasileiro de diálise. Essencialmente, os pacientes em hemodiálise tiveram maior incidência de infecções por covid-19, mas aqueles em diálise peritoneal desenvolveram quadros mais graves, com maior necessidade de internação, suporte ventilatório e tratamento intensivo, e mais elevada letalidade; os autores sugerem então parcimônia na indicação de troca de modalidade (de hemodiálise para diálise peritoneal) com vistas à proteção de pacientes renais crônicos, aventada no início da pandemia 5 .…”

“…Além disso, a aplicação de dose vacinal de reforço (mRNA) em pacientes em diálise peritoneal conduz à otimização da resposta na maioria dos pacientes 8 . Por deter-se em período no qual os esquemas vacinais não tiveram ainda a plena aplicação na população renal crônica, a maior mortalidade em diálise peritoneal observada por Gorayeb-Polacchini et al 4 pode refletir a falha do status vacinal à época.…”

“…Estamos ainda aprendendo sobre o impacto da pandemia nos renais crônicos e sobre estratégias pragmáticas de proteção. Os dados do estudo de Gorayeb-Polacchini et al 4 são muito bem-vindos num cenário tão inexplorado como o que enfrentamos, e convida-nos a um alerta essencial, a ser mantido vivo na lembrança, em que pese o contrapeso de um contexto em que prevalece ampla vacinação e o ganho expressivo de expertise das organizações assistenciais.…”

Living is very dangerous: dialysis in the pandemic

“…The study by Gorayeb-Polacchini et al 4 helps us understand how the pandemic impacted patients in a Brazilian dialysis program. Essentially, hemodialysis patients had a higher incidence of infections by covid-19, but those on peritoneal dialysis developed more severe conditions, with greater need for hospitalization, ventilatory support, intensive care, and higher lethality; the authors then suggest parsimony in the indication of changing the modality (from hemodialysis to peritoneal dialysis) aiming to protect chronic kidney patients, suggested at the beginning of the pandemic 5 .…”

“…In addition, the application of a booster vaccine dose (mRNA) in patients on peritoneal dialysis leads to response optimization in most patients 8 . Due to the fact that the vaccine schedules were not yet fully applied in the chronic kidney population, the higher mortality in peritoneal dialysis reported by Gorayeb-Polacchini et al 4 may reflect the failure of the vaccine status at the time.…”