COVID-19-Related Mortality in Hemodialysis Patients

Among comorbidities associated with predisposition to severe COVID-19, dialysis confers the highest risk of mortality. However, according to Sol Carriazo, MD, and colleagues, reports of COVID-19 associated mortality most frequently refer to mortality occurring during the initial hospitalization in the first month following COVID-19 diagnosis.

Dr. Carriazo et al. reported results of a prospective observational study designed to analyze the long-term (1-year follow-up) serological and clinical outcomes of 56 patients on hemodialysis who were infected by severe SARS-CoV-2 during the first wave of the pandemic. COVID-19 was diagnosed by a positive polymerase chain reaction (PCR) test (n=37) or by the development of anti-SARS-CoV-2 antibodies (n=19).

After 1-year of follow-up, 35.7% of the hemodialysis patients infected by SARS-CoV-2 during the study period had died; of those, six (11%) died during the initial hospital admission and 14 (25%) in the following months, primarily within the first 3 months following diagnosis. Of the patients that died, 30% died from vascular causes and 40% from respiratory causes.

In adjusted analysis, there were associations between a positive SARS-CoV-2 PCR test for diagnosis (hazard ratio [HR], 5.18; P=.020), higher baseline C-reactive protein levels (HR, 1.10; P=.002), and lower hemoglobin levels (HR, 0.62; P=.005) and a higher 1-year mortality.

In the 144 patients who did not have COVID-19, mortality was 21 (14.6%) over 12 months; HR for death in COVID-19 patients 3.00; P=.00023. Over the first year, the percentage of patients having anti-SARS-CoV-2 immunoglobulin G (IgG) decreased from 73.4% (n=36/49) initially to 61.3% (n=27/44) at 6 months and 38.8% (n=14/36) at 12 months.

In conclusion, the authors said, “The high mortality of hemodialysis patients with COVID-19 is not limited to the initial hospitalization. Defining COVID-19 deaths as those occurring within 3 months of a COVID-19 diagnosis may better represent the burden of COVID-19. In hemodialysis patients, the anti-SARS-CoV-2 IgG response was suboptimal and short-lived.”