Dialysis Patients Have Higher COVID-19 Mortality Rates

A new study suggests that SARS-CoV-2 infection affects a significant percentage of renal replacement therapy (RRT) patients.

A new report by researchers at Hospital Clínic de Barcelona (Spain), Hospital Universitario La Paz (Madrid, Spain), and other members of the Spanish Society of Nephrology (SEN) conducted an analysis of the new SEN online COVID-19 registry, which began operating on March 18th, 2020, and which includes all RRT patients treated in the Spanish autonomous communities. All suspected patients were diagnosed with SARS-CoV-2 infection based on the results of a polymerase chain reaction (PCR) test of the virus.

The most represented form of RRT was in-center hemodialysis (ICH), followed by transplant patients. COVID-19 symptoms among them were similar to the general population. The results showed that a very high percentage (85%) required hospital admission, 8% in intensive care units (ICUs). Mortality was also high, reaching 23%; deceased patients were more frequently on ICH, developed pneumonia more frequently, and received less lopinavir–ritonavir and steroids. Age and pneumonia were independently associated with the risk of death. The study was published on May 1, 2020, in Nefrologia.

“Dialysis patients with SARS-CoV-2 infection have a higher risk of dying than transplant patients, probably related to older age and comorbidity,” concluded lead author J. Emilio Sánchez-Álvarez, MD, of Hospital Universitario de Cabueñes (Gijón, Spain), and colleagues. “Analysis of factors independently associated with the risk of death show that age and the development of pneumonia determine a worse prognosis. Furthermore, in the group of patients on dialysis, the use of hydroxychloroquine is associated with a lower rate of deaths; however, the significance of this last finding requires studies in a larger number of patients.”

Another study, conducted at Hospital Gregorio Marañón (Madrid, Spain) confirmed that the death rate in RRT patients in Spain was as high as 30.5%. The study also analyzed predictors of mortality, finding that in addition to patient older age and pneumonia, three factors significantly influence the mortality rate among coronavirus-positive RRT patients: the number of years on dialysis; lymphopenia, which describes a low number of lymphocytes; and elevated lactate dehydrogenase (LDH) levels, a surrogate for tissue damage.

Related Links:
Hospital Clínic de Barcelona
Hospital Universitario La Paz