Kidney Week

Abstract: SA-OR07

COVID-19 Pandemic Effect on Mortality of Hemodialysis Patients

Session Information

• COVID-19 and Kidney Diseases: Mechanisms and Management
  November 05, 2022 | Location: W230, Orange County Convention Center‚ West Building
  Abstract Time: 05:24 PM - 05:33 PM

Category: Coronavirus (COVID-19)

• 000 Coronavirus (COVID-19)

Authors

• Zhang, Yan, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

Yan Zhang, PhD

• Neri, Luca, Fresenius Medical Care Italia SpA, Palazzo Pignano, Lombardia, Italy

Luca Neri,

• Carioni, Paola, Fresenius Medical Care Italia SpA, Palazzo Pignano, Lombardia, Italy

Paola Carioni,

• Arkossy, Otto, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

Otto Arkossy,

• Stauss-Grabo, Manuela, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

Manuela Stauss-Grabo,

• Laukhuf, Frank M., Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

Frank M. Laukhuf,

• Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Len A. Usvyat,

• Stuard, Stefano, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

Stefano Stuard,

• Winter, Anke, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

Anke Winter,

Background

COVID-19 was associated with significant excess mortality among dialysis patients. We aimed to assess mortality risk of patients with confirmed COVID-19 infection (COVID-19+) versus other hemodialysis (HD) patients, and its relation to COVID-19 pandemic in general population (GP).

Methods

We included 63,216 HD patients treated in 2019-2020 at NephroCare centers of 23 countries from European Clinical Database (EuCliD®). Mortality risk per calendar month in 2020 was estimated separately for COVID-19+ and other HD patients using Cox regression models, with COVID-19 status as a time-varying covariate and patients per month in 2019 as reference. The correlation between monthly mortality risk and numbers of COVID-19 cases and deaths in GP were evaluated.

Results

Monthly treated patients were 42,000-43,000 (Fig1). In line with two waves of pandemic in GP, two fluctuations of mortality risk were observed for both COVID-19+ and other HD patients (Fig1). Mortality risk of COVID-19+ patients persisted at much higher levels across 2020, with adjusted hazard ratios (HR)>6.5, whereas mortality risk of other HD patients elevated slightly (HRs<1.5) and mainly during the pandemic peak period (Fig1). Correlation of mortality risk with pandemic in GP were higher for other HD patients (spearman correlation coefficients [ρ] of HRs with the numbers of COVID-19 cases/deaths in GP, 0.77/0.44) than for COVID-19+ HD patients (ρ, -0.10/0.42).

Conclusion

COVID-19 pandemic had direct and indirect impact on mortality of HD patients. Potential reasons of increased mortality in patients without confirmed COVID-19 diagnosis could be undertesting or healthcare system capacity constraints. Quantifying the magnitude of pandemics on patients with/without confirmed disease may benefit dialysis clinics to manage patients during critical events.

Funding

• Commercial Support – Fresenius Medical Care