Prevalence and predictors of outcomes among ESRD patients with COVID-19

Abstract

Background End-stage renal disease patients on hemodialysis (ESRD) patients are at high risk for contracting COVID-19. In this propensity matched cohort study, we examined the prevalence of COVID-19 in emergency room (ER) patients and examined whether clinical outcomes varied by ESRD status. Methods Patients who visited George Washington University Hospital ER from April 2020 to April 2021 were reviewed for COVID-19 and ESRD status. Among COVID-positive ER patients, the propensity for ESRD was calculated using a logistic regression model to create a propensity-matched sample of ESRD vs non-ESRD COVID-19 patients. A multivariable model examined whether ESRD was an independent predictor of death and other outcomes in COVID-19 patients. Results Among the 27,106 ER patients, 2689 of whom were COVID-positive (9.9%). The odds of testing positive for COVID-19 were 0.97 ([95% CI: 0.78–1.20], p = 0.76) in ESRD vs non-ESRD patients after adjusting for age, sex, and race. There were 2414 COVID-positive individuals with non-missing data, of which 98 were ESRD patients. In this COVID-positive sample, ESRD patients experienced a higher incidence of stroke, sepsis, and pneumonia than non-ESRD individuals. Significant independent predictors of death included age, race, sex, insurance status, and diabetes mellitus. Those with no insurance had odds of death that was 212% higher than those with private insurance (3.124 [1.695–5.759], p < 0.001). ESRD status was not an independent predictor of death (1.215 [0.623–2.370], p = 0.57). After propensity-matching in the COVID-positive patients, there were 95 ESRD patients matched with 283 non-ESRD individuals. In this sample, insurance status continued to be an independent predictor of mortality, while ESRD status was not. ESRD patients were more likely to have lactic acidosis (36% vs 15%) and length of hospital stay ≥ 7 days (48% vs 31%), but no increase in odds for any studied adverse outcomes. Conclusions In ER patients, ESRD status was not associated with higher odds for testing positive for COVID-19. Among ER patients who were COVID positive, ESRD was not associated with mortality. However, insurance status had a strong and independent association with death among ER patients with COVID-19.

Association between Socio-demographic and Clinical Factors and Health Outcomes among COVID-19 Patients in a Community Hospital in Alabama

“…Consistent with this observation, the current study shows that patients with obesity stayed in the hospital longer, costed more to treat, had higher mortality, and more often needed rehab or skilled nursing after discharge. Several studies have reported that ESRD patients with COVID infection have higher mortality and higher odds of staying in the hospital 7 days or longer [49][50][51][52]. To our knowledge, no study has reported the difference in hospital cost between patients with and without ESRD.…”

End-stage kidney disease patients with severe coronavirus disease: clinical characteristics, biological data, and mortality in nephrology unit, short communication

“…In the first recent study, the authors found that without adjustment, ESKD patients hospitalized for COVID-19 had a significantly higher odds of in-hospital death than patients without ESKD, but once comprehensively adjusted, there was no excess risk of death for ESRD patients 10 . In the second study, the authors found that among individuals with COVID-19-positive test result, ESKD patients did not have a higher odd for adverse outcomes (mortality, stroke, shock, intubation, sepsis, pneumonia) compared with matched individuals without ESKD 11 . The objective of this study was to determine the clinical, biological, and radiological characteristics on admission and mortality in patients presenting ESKD with severe COVID-19.…”