COVID-19 and Survival in Maintenance Dialysis

Abstract

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COVID-19 Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider

“…Though COVID-19 care in dialysis patients remains largely supportive, practices implemented at the systems level can be impactful. Similar to other studies, 17 , 19 about 60% of COVID-positive dialysis patients have been hospitalized, translating to a need for adequate resource planning for in-hospital dialysis equipment, consumables, and staffing to minimize strain, particularly given the associated system strain with the high incidence of acute kidney injury requiring dialysis among critically ill COVID-19 patients. With admissions averaging eleven days’ duration in an already-frail population, a number of patients may be expected to need rehabilitation; therefore coordination among hospitals, dialysis centers, rehabilitation facilities and long-term care facilities is critical to avoid medical errors and readmissions.…”

“…Lastly, this study and others demonstrate that mortality exceeds 20% among maintenance dialysis patients. [17][18][19]28,29 Therefore discussions around advance care planning should be considered to avoid aggressive medical therapy when it is incongruent with one's life goals and values; this is particularly true of those with advanced age and with other indicators of frailty, which were associated with mortality in our study. The appropriate planning for and implementation of palliative care and hospice is critical in this population, particularly with the devastating impact of acute illnesses like COVID-19.…”

“…[9][10][11][12] Studies in China, Italy, the UK, New York, and southern California show that maintenance dialysis patients with COVID-19 experience higher mortality and more severe disease compared to the general population. [13][14][15][16][17][18][19] In the latest United States Renal Data Systems Annual Report, approximately 524,000 patients were receiving dialysis in the country as of 2017, constituting a large at-risk population. 11 By June of 2020, the Centers for Medicare & Medicaid Services reported a COVID-19 prevalence of 3.8% in the dialysis population, 20 but further characterization is needed.…”

Immunogenicity of SARS-CoV-2 Vaccine in Dialysis

“…Of note, potential immunosuppressed states and acute hospitalization during the vaccine series have face validity to impact immune response, particularly in the setting of uremic inflammation. 7,12,15 Considering the devastating impact of COVID-19 on dialysis patients compared to the potentially dramatic benefit of vaccination on severity of illness, [3][4][5] it is imperative to explore strategies to monitor and maximize seroconversion. Such knowledge may be useful for patient education and dialogue to reinforce preventive measures.…”

“…Nearly 550,000 people in the United States (US) receive maintenance dialysis and prevalence estimates approach 3 million worldwide. 1,2 Patients receiving maintenance dialysis (henceforth "dialysis patients"), particularly those receiving hemodialysis, comprise a population of vulnerable individuals who cannot self-isolate, have a high incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and have Coronavirus Disease 2019 (COVID-19)associated mortality of 15 to 25%, [3][4][5] making effective vaccination a priority. Despite this heightened risk and prior reports of diminished response to vaccines versus other viruses such as hepatitis-B and influenza, [6][7][8] the immune response to SARS-CoV-2 vaccination among dialysis patients is unknown due to insufficient trial data.…”