Epidemiology of COVID-19 Infection in Hospitalized End-Stage Kidney Disease Patients in a Predominantly African-American Population

Abstract

<b><i>Background:</i></b> End-stage kidney disease patients on dialysis are particularly susceptible to COVID-19 infection due to comorbidities, age, and logistic constraints of dialysis making social distancing difficult. We describe our experience with hospitalized dialysis patients with COVID-19 and factors associated with mortality. <b><i>Methods:</i></b> From March 1, 2020, to May 31, 2020, all dialysis patients admitted to 4 Emory Hospitals and tested for COVID-19 were identified. Sociodemographic information and clinical and laboratory data were obtained from the medical record. Death was defined as an in-hospital death or transfer to hospice for end-of-life care. Patients were followed until discharge or death. <b><i>Results:</i></b> Sixty-four dialysis patients with COVID-19 were identified. Eighty-four percent were African-American. The median age was 64 years, and 59% were males. Four patients were on peritoneal dialysis, and 60 were on hemodialysis for a median time of 3.8 years, while 31% were obese. Fever (72%), cough (61%), and diarrhea (22%) were the most common symptoms at presentation. Thirty-three percent required admission to intensive care unit, and 23% required mechanical ventilation. The median length of stay was 10 days, while 11 patients (17%) died during hospitalization and 17% were discharged to a temporary rehabilitation facility. Age >65 years (RR 13.7, CI: 1.9–100.7), C-reactive protein >100 mg/dL (RR 8.3, CI: 1.1–60.4), peak D-dimer >3,000 ng/mL (RR 4.3, CI: 1.03–18.2), bilirubin >1 mg/dL (RR 3.9, CI: 1.5–10.4), and history of peripheral vascular disease (RR 3.2, CI: 1.2–9.1) were associated with mortality. Dialysis COVID-19-infected patients were more likely to develop thromboembolic complications than those without COVID-19 (RR 3.7, CI: 1.3–10.1). <b><i>Conclusion:</i></b> In a predominantly African-American population, the mortality of end-stage kidney disease patients admitted with COVID-19 infection was 17%. Age, C-reactive protein, D-dimer, bilirubin, and history of peripheral vascular disease were associated with worse survival.

Biological drugs for systemic lupus erythematosus or active lupus nephritis and rates of infectious complications. Evidence from large clinical trials

“…The presence of kidney disease is a risk factor for poor outcomes of severe infections such as COVID-19 (32)(33)(34)(35)(36), and infections are the second common cause of death in patients with CKD (37)(38)(39). This has been attributed to secondary immunodeficiency (SIDKD) to which many of the consequences of kidney disease contribute (8).…”

Safety and efficacy of coronavirus disease‐19 vaccines in chronic kidney disease patients under maintenance hemodialysis: A systematic review

“…The reasons for increased risk of symptomatic infection are impaired immunological status, chronic inflammation, high oxidative stress, accumulated uremic toxins, and endothelial dysfunction 3 . The complications like acute respiratory distress syndrome (ARDS), acute cardiac injury, shock, and arrhythmias are higher in patients under dialysis, and mortality is reported higher 14% versus 4% in comparison to patient not infected with COVID‐19 4 . Thus, to decrease the morbidity and mortality, it is essential to protect CKD patients from COVID‐19 and its complications.…”

The relationship between CT value and clinical outcomes in renal patients with COVID-19

“…Oto et al observed that factors such as ischemic heart diseases and inadequate transplant function were among the leading causes of higher mortality following COVID-19 in individuals over the age of 60 [ 28 ]. In another study, on a predominantly African-American population, increasing age was linked to worsening prognosis in chronic renal patients with COVID-19 infection [ 29 ].…”