Introduction
Patients on dialysis are particularly vulnerable to coronavirus disease 2019 (COVID-19), with multiple studies describing mortality over 20% worldwide. In-center Hemodialysis (HD) patients face a higher risk of morbidity and mortality compared to home-based Peritoneal Dialysis (PD) patients. We describe the outcomes of COVID-19 infection among our in-center HD and home-based PD patients and their contributing factors.
Methods
This retrospective observational study included all COVID-19 hospitalization among End-Stage Kidney Disease (ESKD) patients on maintenance dialysis. Clinical, laboratory, and demographical data were obtained from four main centers in Negeri Sembilan from 1st February 2020 till 31stJuly 2021.
Results
In our state, we had a total of 206 patients with ESKD on maintenance dialysis hospitalized for COVID-19 infection. The majority of our patients were male 114 (55.3%) and Malay ethnic 140 (68%). In-centre HD patients were older (57 ± 12 vs 49 ± 13 years) compared to home-based PD with an almost similar rate of comorbidities in both groups. PD patients had milder COVID-19 presentation 8 (36%) compared to HD 32 (17%). Both HD and PD patients received supportive medical therapy as the main treatment for COVID-19 infection, {100 (54%) and 13 (59%)} respectively.
Among COVID-19 admissions, we found higher admissions for in-center HD patients 184 (89%) compared to home-based PD patients 22 (11%). However, PD patients 20 (91%) required longer duration of hospitalization (>7 days) compared to HD 143 (78%) with both having equal need for mechanical ventilation {3 (14%) and 23 (13%)} respectively. In hospital mortality {35 (19%) vs 2 (9%)} and post COVID-19 mortality {7 (5%) vs 0 (0%)} was higher in HD compared to PD patients.
Factors associated with in-hospital mortality for our patients were age (P=0.02), COVID-19 category (P<0.001), the requirement of mechanical ventilation (P<0.001), Absolute lymphocyte count (ALC) (P=0.001), Absolute neutrophil count (ANC) (P<0.001), C-reactive protein (CRP) (P<0.001) and albumin levels (P=0.009).
On multivariate analysis, an increase in age for 1 year was associated with higher mortality (OR 1.046; 95%CI 1.007-1.086; P=0.02), the requirement of mechanical ventilation (OR 17.431; 95%CI 5.740-52.932; P<0.001), the value of ALC (OR 0.381; 95%CI 0.168-0.865; P=0.02) and value of CRP (OR 1.009; 95%CI 1.004-1.013; P<0.001) showed significant impact on mortality. Vaccination and other comorbidities such as diabetes and hypertension did not have any influence on mortality and duration of hospitalizations.
Conclusions
COVID-19 mortality was higher among In-center HD compared to home-based PD patients but did not reach statistical significance. Age, clinical severity, and laboratory values played a significant role in the mortality of ESKD patients hospitalized with COVID-19 infection.
No conflict of interest