COVID-19 in patients undergoing long-term dialysis in Ontario

Abstract

populous province, almost 41 000 people had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), 1 which represented 0.3% of the provincial population. Close to 2800 people had died, a case fatality rate of 6.8%. 2 Patients undergoing dialysis have high rates of comorbid conditions, are often older adults, have varying degrees of immunosuppression and are more likely to reside in long-term care, which puts them at risk of both acquiring SARS-CoV-2 and developing complicated disease. 3,4 Furthermore, in Ontario, those who receive in-centre hemodialysis typically have 3 treatments per week in outpatient units located in or affiliated with hospitals, and the consequent inability to fully selfisolate means that patients undergoing hemodialysis likely have an even higher risk of SARS-CoV-2 infection. 3,4 Recent studies support this but do not compare infection rates with those in the local population of patients not undergoing dialysis. 5-10 Several studies have reported SARS-CoV-2 infection in single or multicentre cohorts of patients undergoing dialysis, 5-10 but we are unaware of any that have identified risk factors for infection at the level of a large region. Some studies have found that patients with SARS-CoV-2 infection who are undergoing dialysis are at high risk of severe illness and death. 6-10 Methods Study setting Ontario has a population of about 14.5 million. More than 12 000 people receive long-term dialysis, with about 74% receiving in-centre hemodialysis and 26% home dialysis, which comprises 21% peri toneal dialysis and 5% home hemodialysis. All dialysis in Ontario is funded by a single payer-the provincial government-operating through the Ontario Renal Network (ORN), a provincial agency that funds and manages services for patients with chronic kidney disease within 27 Renal Programs, which provide home dialysis services and operate more than 100 in-centre hemodialysis units. 11 The latter vary in size from 3 to 60 hemodialysis stations. To understand the impact of SARS-CoV-2 on RESEARCH VULNERABLE POPULATIONS COVID-19 in patients undergoing long-term dialysis in Ontario

Extremely high mortality in COVID-19 hemodialyzed patients in before anty-SARS-CoV-2 vaccination era. The first large database from Poland

“…The number of new infections increased strongly between mid-September, when the beginning of the postvacation wave of illnesses was observed, and mid-November, when the case rate of the second wave of the pandemic peaked in coincidence with the peak incidence of the general population. The decline in the incidence curve in the HD population proceeded earlier and faster than in the general population, similar to the data reported from Ontario and Flanders [8,9]. Earlier suppression of disease dynamics in HD patients may just have been influenced by prevention plans implemented in all dialysis units including, inter alia the universal use of surgical masks by patients during transport and dialysis, stationary quarantine in the event of contact with an infected person, assessment of the patients by the staff with an epidemiological interview and body temperature measurement before admission to the unit, an early examination of the patient (nasopharyngeal swab) suspected COVID-19 and the dialysis of patients with COVID-19 in a dedicated unit.…”

“…The first wave of new cases of COVID-19 in spring 2020 was flat and was probably held back by an early national lockdown. The increase in the number of new cases during the second wave of the epidemic in autumn occurred earlier in the HD population as compared to controls, similar to what was observed in the dialyzed population of Ontario [8]. Interestingly, at the end of the observed period, the beginning of the third wave of cases is noticeable among HD patients but not yet visible in the general population (Figure 2).…”

“…A preliminary report from a single region of Poland showed a high mortality rate among HD patients confirmed with COVID-19 during the first wave of the pandemic in spring 2020 [5]. Early case series reports from different countries suggest that case fatality in HD patients varied from 20.3 to 29.6% with a higher incidence rate than in the general population [6][7][8][9][10]. Most of them were single center studies and had a relatively short follow-up period.…”

„Coronavirus-disease-2019“-Pandemie aus nephrologischer Perspektive

“…Dieser Unterschied bestand auch nach Adjustierung für demografische Angaben und Komorbiditäten [ 8 ]. Dass chronische Nierenerkrankungen und insbesondere eine Dialysepflichtigkeit zu den Risikofaktoren für eine schwer verlaufende COVID-19 zählen, wurde durch Registerstudien aus Europa, Kanada und den USA bestätigt, die über eine COVID-19-Letalität von 20–40 % bei Dialysepatienten berichten [ 9 – 17 ]. Im Rahmen einer globalen Pandemie muss jedoch berücksichtigt werden, dass Registerdaten nicht immer auf andere Länder übertragbar sind, da die Gesundheitssysteme, die Dynamik der Pandemieentwicklung, staatliche Maßnahmen etc.…”

“…Die Letalität der COVID-19-Dialysepatienten in Deutschland war im Sommer 2020 mit über 20 %, bezogen auf die Anzahl der an COVID-19 erkrankten Dialysepatienten, sehr hoch und auf einem mit anderen Industrienationen vergleichbaren Niveau [ 9 – 17 ]. Diese hohe Letalität, die der COVID-19-Letalität in der Bevölkerungsgruppe mit dem höchsten Risiko in Deutschland (d. h. Personen über 80 Jahre) entspricht, weist auf die hohe Bedeutung von Präventivmaßnahmen zur Verhinderung von COVID-19 bei Dialysepatienten hin.…”