End-Stage Renal Disease Patients on Chronic Hemodialysis Fare Better With COVID-19: A Retrospective Cohort Study From the New York Metropolitan Region

Abstract

Introduction Several comorbid conditions have been identified as risk factors in patients with coronavirus disease 2019 (COVID-19). However, there is a dearth of data describing the impact of COVID-19 infection in patients with end-stage renal disease on hemodialysis (ESRD-HD). Methods This retrospective case series analyzed 362 adult patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020, and May 13, 2020, at a teaching hospital in the New York City metropolitan area. The primary outcome was severe pneumonia as defined by the World Health Organization. Secondary outcomes were the (1) the Combined Outcome of Acute respiratory distress syndrome or in-hospital Death (COAD), and (2) need for high levels of oxygen supplementation (HiO 2). Results Patients with ESRD-HD had lower odds for poor outcomes including severe pneumonia [odds ratio (OR) 0.4, confidence interval (CI) 0.2-0.9, p=.04], HiO 2 [OR 0.3, CI (0.1-0.8), p=.02] and COAD [OR 0.4, CI (0.2-1.05), p=.06], when compared to patients without ESRD. In contrast, higher odds for severe pneumonia, COAD and HiO 2 were seen with advancing age. African Americans were over-represented in the hospitalized patient cohort, when compared to their representation in the community (35% vs 18%). Hispanics had higher odds for severe illness and HiO 2 when compared to Caucasians. Conclusions Patients with ESRD-HD had a milder course of illness with a lower likelihood of severe pneumonia and a lesser need for aggressive oxygen supplementation when compared to patients not on chronic dialysis. The lower odds of severe illness in ESRD-HD patients might have a pathophysiologic basis and need to be further explored.

Clinical presentation and outcomes of chronic dialysis patients with COVID-19: A single center experience from Greece

“…According to the WHO severity score on admission, 50% of patients[ 16 ] presented with mild and 40.6% with moderate disease[ 13 ], while severe disease was observed only in three (9.4%) patients. No patient presented with critical disease.…”

“…Patients on chronic dialysis have been reported to be either more vulnerable[ 11 - 12 ] or rather protected[ 13 - 14 , 25 ]. An international study including dialysis patients concluded that these patients were both more susceptible to severe COVID-19 disease and experienced increased mortality, although with great disparity in mortality rates[ 30 ].…”

“…Notably, the aforementioned co-morbidities are highly prevalent in patients with chronic kidney disease, which is itself considered by default an independent risk factor for increased cardiovascular and all-cause mortality[ 9 - 10 ]. Yet, some studies have reported increased mortality in ESKD patients with COVID-19[ 11 - 12 ], where others have concluded that these patients are somehow being “protected” from the severe form of COVID-19[ 13 - 14 ]. The reported death rates vary substantially across countries[ 15 ] and thus, genetic factors have been implicated to play a role in the development of the severe form of the disease[ 16 ].…”

Renal consequences of the novel coronavirus disease 2019 (COVID-19) and hydrogen sulfide as a potential therapy

“…The authors reported that COVID-19 patients with ESRD had significantly increased leucocyte count, C-reactive protein, lactate dehydrogenase and ferritin, and markedly reduced serum albumin and thrombocytopenia with a higher in-hospital mortality (18%) compared to their counterparts without ESRD (10%) [ 53 ]. Another study also reported that COVID-19-positive patients who had ESRD and on dialysis had better outcomes than ESRD patients who were not on dialysis [ 54 ]. They attributed their observation to a possible “pre-conditioning”, where underlying chronic inflammation in ESRD patients on dialysis attenuates the inflammatory response from the COVID-19 infection.…”

Outcomes of Patients on Maintenance Hemodialysis Admitted to a Tertiary Care Hospital with COVID-19

“…The recent COVID-19 (Coronavirus disease-2019) pandemic due to SARS-CoV-2 (Severe Acute Respiratory Syndrome-Corona Virus 2) 1 , initially emerged during December 2019 in Wuhan city of China 2 and as per WHO (World Health Organization) it has spread to 2012 areas of world countries including Pakistan 3 ; finally acquired the status as "Global Pandemic" on March 11, 2020, by WHO. 4 The COVID-19 has had detrimental effects worldwide 5 as above 38 million cases infected with the SARS-CoV-2 were reported globally. 6 In Pakistan, the Coronavirus pandemic outbreak occurred in February 2020.…”