Risk prediction of COVID-19 incidence and mortality in a large multi-national hemodialysis cohort: implications for management of the pandemic in outpatient hemodialysis settings

Abstract

Background Experiences from the first wave of the 2019 coronavirus disease (COVID-19) pandemic can aide in the development of future preventive strategies. To date, risk prediction models for COVID-19-related incidence and outcomes in haemodialysis (HD) patients are missing. Methods We developed risk prediction models for COVID-19 incidence and mortality among HD patients. We studied 38 256 HD patients from a multi-national dialysis cohort between March 3rd and July 3rd 2020. Risk prediction models were developed and validated, based on predictors readily available in outpatient haemodialysis units. We compared mortality among patients with and without COVID-19, matched for age, sex, and diabetes. Results During the observational period, 1 259 patients (3.3%) acquired COVID-19. Of these, 62% were hospitalised or died. Mortality was 22% among COVID-19 patients with odds ratios 219.8 (95% CI 80.6-359) to 342.7 (95% CI 60.6-13595.1), compared to matched patients without COVID-19. Since the first wave of the pandemic affected mostly European countries during the study, the risk prediction model for incidence of COVID-19 was developed and validated in European patients only (N = 22 826, AUCDev 0.64, AUCVal 0.69). The model for prediction of mortality was developed in all COVID-19 patients (AUCDev 0.71, AUCVal 0.78). Angiotensin receptor blockers were independently associated with a lower incidence of COVID-19 in European patients. Conclusions We identified modifiable risk factors for COVID-19 incidence and outcome in HD patients. Our risk prediction tools can be readily applied in clinical practice. The current study can aid in the development of preventive strategies for future waves of COVID-19.

Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients

“…For example, the rate of vaccination failure for hepatitis B vaccination was 28.3% of hemodialysis patients, but < 10% in the normal population [ 4 ]. Hemodialysis patients also have a higher risk of becoming infected with COVID-19 and, when infected, have a higher associated mortality rate than the normal population [ 5 , 6 ]. The immunogenicity and tolerability of SARS-CoV-2 vaccines may also differ in hemodialysis patients compared to the general population.…”

Immunogenicity of a first dose of mRNA- or vector-based SARS-CoV-2 vaccination in dialysis patients: a multicenter prospective observational pilot study

“…Several two-dose SARS-CoV-2 vaccines have been approved to prevent COVID-19 infection, with a reported vaccine efficacy of 90–95% in the normal population after the second dose. Dialysis patients are at high risk for COVID-19 infection and mortality [ 1 , 2 ] but were not included in the vaccination registration trials. Small observational studies showed a sufficient immune response several weeks after the second SARS-CoV-2 mRNA-based vaccination [ 3 , 4 ].…”

Renal involvement in COVID-19: focus on kidney transplant sector

“…Several studies reported a 20-30% mortality rate in kidney transplant recipients hospitalized for COVID-19 [80,[128][129][130][131]. Accordingly, the French IMPORTANT study noted that the absolute number of deaths found in April 2020 was more than twofold higher than those observed in April 2018 and in April 2019 [132].…”