To the Editor:
We read with interest the recent publication by Shieu and colleagues about the longitudinal trends in hospitalization and mortality among individuals receiving maintenance dialysis before and during the coronavirus disease (COVID)-19 pandemic.1 Although it is an interesting study, several limitations require attentions.
The authors concluded that non-COVID-19 mortality declined during the early phase of the pandemic and subsequently remained below prepandemic levels. The COVID-19-related death was defined as a death occurring within 90 days of COVID-19 diagnosis.1 However, for acute COVID-19 infections in 2020, most frail patients died within 30 days post infection. On the contrary, 90 days may be too short to study the long COVID-19 syndromes.2 Schuller et al3 specified “COVID-19 related mortality” as death within 30 days post infection. Thus, the non-COVID-19 mortality may be underestimated in this study.
Second, a large number of dialysis patients with autoimmune diseases used immunosuppressants, which reduced antibody responses to COVID-19 vaccines.4 When accessing the role of vaccination on mortality, this factor should be considered.
Third, higher all-cause hospitalization and mortality rates were observed among patients receiving in-center dialysis compared with patients receiving home dialysis.1 The authors presumed that home dialysis patients tended to be younger with fewer comorbid conditions. Nevertheless, the nursing home experience may also be attributed to congregate living, the inability to socially distance, and higher frailty and comorbid condition burden.5 A contradictory report indicated that home dialysis was associated with higher mortality5, which should be further discussed.
Article Information
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Financial Disclosure
The authors declare that they have no known financial interests.
Peer Review
Received May 25, 2025. Evaluated by the Editor-in-Chief. Accepted June 30, 2025.
References
- 1.Shieu M.M., Weiner D.E., Li N.C., et al. COVID-19 hospitalization and mortality trends among US dialysis patients by race/ethnicity and vaccination status. Kidney Med. 2025;7(7) doi: 10.1016/j.xkme.2025.101026. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 4.Smith R.M., Cooper D.J., Doffinger R., et al. SARS-CoV-2 vaccine responses in renal patient populations. BMC Nephrol. 2022;23(1):199. doi: 10.1186/s12882-022-02792-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Salerno S., Messana J.M., Gremel G.W., et al. COVID-19 risk factors and mortality outcomes among Medicare patients receiving long-term dialysis. JAMA Netw Open. 2021;4(11) doi: 10.1001/jamanetworkopen.2021.35379. [DOI] [PMC free article] [PubMed] [Google Scholar]