COVID-19 Infection Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider

Hsu, Caroline M.; Weiner, Daniel E.; Aweh, Gideon; Miskulin, Dana C.; Manley, Harold J.; Stewart, Carol; Ladik, Vlad; Hosford, John; Lacson, Edward C.; Johnson, Douglas S.; Lacson, Eduardo

RATIONALE & OBJECTIVE: During the COVID-19 pandemic, patients receiving maintenance dialysis are a highly vulnerable population due to their comorbidities and circumstances that limit physical distancing during treatment. This study sought to characterize the risk factors for and outcomes following COVID-19 infection in this population. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Maintenance dialysis patients in clinics with at least one patient with a positive test for SARS-CoV-2 from February to June 2020, treated by a mid-size national dialysis provider. PREDICTORS: Demographics, dialysis characteristics, residence in a congregate setting, comorbid conditions, measures of frailty, and use of selected medications. OUTCOMES: COVID-19 defined as having a positive SARS-CoV-2 test and all-cause mortality among those with COVID-19. ANALYTICAL APPROACH: Logistic regression analyses to identify clinical characteristics associated with COVID-19and risk factors associated with mortality among patients following COVID-19. RESULTS: 438/7948 (5.5%) maintenance dialysis patients developed COVID-19. Male sex, Black race, in-center dialysis (vs. home dialysis), treatment at an urban clinic, residence in a congregate setting, and greater comorbidity were associated with contracting COVID-19. Odds of COVID-19 was 17-fold higher for those residing in a congregate setting [OR = 17.10 (95% CI 13.51, 21.54)]. Of the 438 maintenance dialysis patients with COVID-19, 109 (24.9%) died. Older age, heart disease, and markers of frailty were associated with mortality. LIMITATIONS: No distinction between symptomatic and asymptomatic SARS-CoV-2 positivity, with asymptomatic screening limited by testing capacity during this initial COVID-19 surge period. CONCLUSIONS: COVID-19 is common among patients receiving maintenance dialysis, particularly those residing in congregate settings. Among maintenance dialysis patients with COVID-19, mortality is high, exceeding 20%.