Abstract: PUB156
COVID-19 Pandemic in Dialysis: Urban and Suburban Outcomes in a Small Dialysis Organization
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Kore, Shruti, New York Medical College, Valhalla, New York, United States
- Coritsidis, George N., Westchester Medical Center, Valhalla, New York, United States
- Weiss, Steven, Atlantic Dialysis Management Services, New York, New York, United States
Background
The COVID-19 pandemic was devastating to the ESRD population, contributing to a decrease in prevalence of dialysis patients. Atlantic Dialysis Management Services (ADMS), a small dialysis organization, provides dialysis to the NYC and Long Island areas. We reported early findings, in 2020, describing increased mortality, and reviewed the progression of these findings into 2021.
Methods
A retrospective EMR review of 13 ADMS facilities comprising 4 boroughs of NYC and Long Island from February 1, 2020 to August 31, 2020 Wave (W1) and September 1, 2020 to February 28, 2021 Wave (W2). Aggregate data was used to calculate values for combined wave categories. We reviewed the demographic characteristics, COVID-19 status, years on dialysis (vintage), mortality (overall and COVID-19 related), presence/absence of a social security number, insurance, and comorbidities. Adjusted odds ratio analysis was performed.
Results
There were 2147 patients in Wv1 and 1658 in Wv2. The total ADMS population decreased by 22.8% by Wv2 with a total of 911 deaths, despite admissions. 215 or 31% were covid related deaths in W1, decreasing to 11% in W2. Living in NYC and being Hispanic had significantly higher odds ratio for infectivity and COVID related mortality in W1 but not in W2. COVID-19 related mortality was significantly associated with age, vintage, ethnicity, and dialyzing in a NYC borough. Patient infection, overall deaths, and COVID-19 related deaths on Long Island more than doubled from W1 to W2. Overall mortality was significantly associated with age, vintage, diabetes, but not ethnicity, and only with NYC boroughs with nursing home patients.
Conclusion
Ethnicity and urban dwelling was associated with increased COVID-19 mortality in W1, but not overall mortality, likely due to housing differences. These factors likely lost significance in W2 due to COVID-19’s spread into other communities. As the pandemic expanded into suburbia, mortality increased, likely due to rapid spread/novelty of the infection, and unique safety challenges. Overall COVID-19 mortality decreased by W2, possibly due to an increased knowledge of infection control and treatment. Mortality's association with age, diabetes, vintage and entities with nursing home patients represents strain on the healthcare system that may be repeated in future pandemics.