Outcomes of symptomatic coronavirus disease 19 in maintenance hemodialysis patient in India

Prasad, Narayan; Behera, Manas Ranjan; Bhatt, Mansi; Agarwal, Sanjay Kumar; Gopalakrishnan, N.; Fernando, Edwin; Chaudhary, Arpita Roy; Sahay, Manisha; Singh, Shivendra; Jain, Apoorva; Tapiawala, Shruti; Kamble, Aniket; Khanna, Umesh; Bohra, Rubina; Gupta, Anurag; Anandh, Urmila; Jha, Vivekanand

BACKGROUND: Maintenance hemodialysis (MHD) patients face disadvantages with higher risk of acquiring SARS‐CoV‐2 infection, atypical manifestations, and associated multiple comorbidities. We describe patients' outcomes with symptomatic COVID‐19 on MHD in a large cohort of patients from India. METHODS: Data were collected prospectively from hemodialysis units in 11 public and private hospitals between March 15, 2020, and July 31, 2020. The survival determinants were analyzed using stepwise backward elimination cox‐regression analysis. RESULTS: Of the 263 total patients (mean age 51.76 ± 13.63 years and males 173) on MHD with symptomatic COVID‐19, 35 (13.3%) died. Those who died were older (p = 0.01), had higher frequency of diabetic kidney disease (p = 0.001), comorbidities (p = 0.04), and severe COVID‐19 (p = 0.001). Mortality was higher among patients on twice‐weekly MHD than thrice‐weekly (p = 0.001) and dialysis through central venous catheter (CVC) as compared to arteriovenous fistula (p = 0.001). On multivariate analysis, CVC use (HR 2.53, 95% CI 1.26–5.07, p = 0.009), disease severity (HR = 3.54, 95% CI 1.52–8.26, p = 0.003), and noninvasive ventilatory support (HR 0.59, 95% CI 0.25–0.99, p = 0.049) had significant effect on mortality. CONCLUSION: The adjusted mortality risk of COVID‐19 in MHD patients is high in patients associated with severe COVID‐19 and patients having CVC as vascular access.