Mortality and associated risk factors of COVID-19 infection in dialysis patients in Qatar: A nationwide cohort study

Abstract

Context Patients on maintenance dialysis are more susceptible to COVID-19 and its severe form. We studied the mortality and associated risks of COVID-19 infection in dialysis patients in the state of Qatar. Methods This was an observational, analytical, retrospective, nationwide study. We included all adult patients on maintenance dialysis therapy who tested positive for COVID-19 (PCR assay of the nasopharyngeal swab) during the period from February 1, 2020, to July 19, 2020. Our primary outcome was to study the mortality of COVID-19 in dialysis patients in Qatar and risk factors associated with it. Our secondary objectives were to study incidence and severity of COVID-19 in dialysis patients and comparing outcomes between hemodialysis and peritoneal dialysis patients. Patient demographics and clinical features were collected from a national electronic medical record. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort. Results 76 out of 1064 dialysis patients were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). During the study period, 7.1% of all dialysis patients contracted COVID-19. Male dialysis patients had double the incidence of COVID-19 than females (9% versus 4.5% respectively; p<0.01). The most common symptoms on presentation were fever (57.9%), cough (56.6%), and shortness of breath (25%). Pneumonia was diagnosed in 72% of dialysis patients with COVID-19. High severity manifested as 25% of patients requiring admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes. The mean length of hospital stay was 19.2 ± -12 days. Mortality due to COVID-19 among our dialysis cohort was 15%. Univariate Cox regression analysis for risk factors associated with COVID-19-related death in dialysis patients showed significant increases in risks with age (OR 1.077, CI 95%(1.018–1.139), p = 0.01), CHF and COPD (both same OR 8.974, CI 95% (1.039–77.5), p = 0.046), history of DVT (OR 5.762, CI 95% (1.227–27.057), p = 0.026), Atrial fibrillation (OR 7.285, CI 95%(2.029–26.150), p = 0.002), hypoxia (OR: 16.6; CI 95%(3.574–77.715), p = <0.001), ICU admission (HR30.8, CI 95% (3.9–241.2), p = 0.001), Mechanical ventilation (HR 50.07 CI 95% (6.4–391.2)), p<0.001) and using inotropes(HR 19.17, CI 95% (11.57–718.5), p<0.001). In a multivariate analysis, only ICU admission was found to be significantly associated with death [OR = 32.8 (3.5–305.4), p = 0.002)]. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high incidence of COVID-19 infection and related mortality compared to previous reports of the general population in the state of Qatar (7.1% versus 4% and 15% versus 0.15% respectively). We also observed a strong association between death related to COVID-19 infection in dialysis patients and admission to ICU.

The vulnerability of maintenance dialysis patients with COVID-19: mortality and risk factors from a developing country

“…Out of 1554 maintenance dialysis patients in the West Bank, 548 acquired COVID-19 during the study period, amounting to 35.3% of the total dialysis population. This rate is much higher than other studies; 7.1% in Qatar [ 11 ] and 12.1% in the United States [ 10 ], for example. This discrepancy might be explained by the variation of the periods through which different studies were conducted; five months in the Qatari study, ten months in the American study and 17 months in ours.…”

“…To the best of our knowledge, our study is the first of its kind coming from a lower-middle-income country. It is also one of the only very few studies done at a national level [ 10 , 11 ].…”

Safety and long-term improvement of mesenchymal stromal cell infusion in critically COVID-19 patients: a randomized clinical trial

“…The incidence of acute kidney injury (AKI) secondary to COVID-19 is high [ 85 ] and is strongly associated with high mortality among hospitalized COVID-19 [ 86 – 88 ]. Ghonimi et al [ 89 ] reported a strong association between death related to COVID-19 infection in dialysis patients, which was also observed in the study of Costa et al [ 90 ], showing that COVID-19 patients with AKI who need dialysis had worse outcomes. Lino et al [ 91 ] also showed that a worse prognosis is frequently associated with a more rapid evolution to intensive and respiratory care or even dialysis.…”

The case for increased peritoneal dialysis utilization in low‐ and lower‐middle‐income countries

“…From a large HD network in India ( n = 14 573), out of 8.8% ( n = 1279) who tested positive for COVID, 22.9% ( n = 293) died most of whom were older patients with multiple comorbidities 116 . Also, a nationwide cohort study from Qatar has reported a higher but non‐statistically significant infection rate as well as COVID‐related deaths in HD compared with PD patients 117 . Although available data on COVID outcomes in patients receiving KRT are scarce in LLMICs, the findings from other regions suggest that PD, which requires minimal interpersonal contact and hospital visits, can be a better KRT modality in a pandemic period.…”

“…The good and the bad of telemedicine use on PD in LLMICs identification of complications Physical examination not possible Pre-emptive prescription management statistically significant infection rate as well as COVID-related deaths in HD compared with PD patients 117. Although available data on COVID outcomes in patients receiving KRT are scarce in LLMICs, the findings from other regions suggest that PD, which requires minimal interpersonal contact and hospital visits, can be a better KRT modality in a pandemic period.11 | TELEMEDICINE TO PROMOTE PDTelemedicine and remote monitoring approaches offer the opportunity to address several of the health challenges in the use of PD for LLMICs identified above.…”