COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis

Key Points Question What are the characteristics and mortality outcomes associated with COVID-19 among Medicare patients undergoing long-term dialysis? Findings This cohort study among 498 169 patients receiving regular maintenance dialysis found several risk factors for COVID-19 that persisted as risk factors for mortality: nursing home status, time on dialysis, congestive heart failure, diabetes, and comorbidity burden. Higher COVID-19 rates were observed among Black patients, while attenuated survival differences were observed between Black and non-Black patients, and although male sex was not associated with a higher COVID-19 rate, it was associated with higher mortality among patients with COVID-19. Meaning These findings suggest that among patients undergoing long-term dialysis, Black race, male sex, nursing home status, and having comorbidities, such as diabetes and cardiac diseases, were associated with higher risk of COVID-19 and higher post–COVID-19 mortality.

[1]  D. Weiner,et al.  Epidemiology and Outcomes of COVID-19 in Home Dialysis Patients Compared with In-Center Dialysis Patients. , 2021, Journal of the American Society of Nephrology : JASN.

[2]  Robert J. Ziemba,et al.  Excess Death Estimates in Patients with End-Stage Renal Disease — United States, February–August 2020 , 2021, MMWR. Morbidity and mortality weekly report.

[3]  E. Lioudaki,et al.  Risk of COVID-19 Disease, Dialysis Unit Attributes, and Infection Control Strategy among London In-Center Hemodialysis Patients , 2021, Clinical journal of the American Society of Nephrology : CJASN.

[4]  K. Bhaskaran,et al.  Ethnic differences in SARS-CoV-2 infection and COVID-19-related hospitalisation, intensive care unit admission, and death in 17 million adults in England: an observational cohort study using the OpenSAFELY platform , 2021, The Lancet.

[5]  K. Johansen,et al.  Initial Effects of COVID-19 on Patients with ESKD , 2021, Journal of the American Society of Nephrology : JASN.

[6]  N. Roetker,et al.  US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States. , 2021, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[7]  Kevin H. Nguyen,et al.  Racial and Ethnic Disparities in Excess Deaths Among Persons With Kidney Failure During the COVID-19 Pandemic, March-July 2020 , 2021, American Journal of Kidney Diseases.

[8]  E. Adashi,et al.  The Centers for Medicare and Medicaid Services (CMS) COVID-19 Brief: Unsettling Racial and Ethnic Health Disparities. , 2021, Journal of the American Board of Family Medicine : JABFM.

[9]  D. Weiner,et al.  COVID-19 Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider , 2021, American Journal of Kidney Diseases.

[10]  H. Peckham,et al.  Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission , 2020, Nature Communications.

[11]  A. O'Hare,et al.  US Clinicians’ Experiences and Perspectives on Resource Limitation and Patient Care During the COVID-19 Pandemic , 2020, JAMA network open.

[12]  P. Bhat,et al.  COVID-19 Infection in ESKD: Findings from a Prospective Disease Surveillance Program at Dialysis Facilities in New York City and Long Island. , 2020, Journal of the American Society of Nephrology : JASN.

[13]  M. Gasparini,et al.  Renal impairment and its impact on clinical outcomes in patients who are critically ill with COVID‐19: a multicentre observational study , 2020, Anaesthesia.

[14]  Lars G. Fritsche,et al.  Characteristics Associated With Racial/Ethnic Disparities in COVID-19 Outcomes in an Academic Health Care System , 2020, JAMA network open.

[15]  C. Wanner,et al.  Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe , 2020, Kidney International.

[16]  W. Winkelmayer,et al.  Nephrology and COVID-19. , 2020, JAMA.

[17]  Jason Y. Adams,et al.  Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States , 2020, American Journal of Kidney Diseases.

[18]  E. Taioli,et al.  Male Sex, Severe Obesity, Older Age, and Chronic Kidney Disease Are Associated With COVID-19 Severity and Mortality in New York City , 2020, Chest.

[19]  K. Reddy,et al.  Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  S. Farhadian,et al.  Sex differences in immune responses that underlie COVID-19 disease outcomes , 2020, Nature.

[21]  R. Gansevoort,et al.  CKD is a key risk factor for COVID-19 mortality , 2020, Nature Reviews Nephrology.

[22]  E. M. Passos,et al.  Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients , 2020, Kidney International.

[23]  M. Abate,et al.  Outcomes of patients with end-stage kidney disease hospitalized with COVID-19 , 2020, Kidney International.

[24]  D. Grabowski,et al.  COVID‐19 in Nursing Homes: Calming the Perfect Storm , 2020, Journal of the American Geriatrics Society.

[25]  P. Kelleher,et al.  High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening. , 2020, Journal of the American Society of Nephrology : JASN.

[26]  J. Weinstein,et al.  COVID-19 Outbreak in an Urban Hemodialysis Unit , 2020, American Journal of Kidney Diseases.

[27]  T. Selden,et al.  COVID-19 And Racial/Ethnic Disparities In Health Risk, Employment, And Household Composition. , 2020, Health affairs.

[28]  K. Jhaveri,et al.  COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings. , 2020, Journal of the American Society of Nephrology : JASN.

[29]  M. Delsante,et al.  Kidney Involvement in COVID-19: Need for Better Definitions. , 2020, Journal of the American Society of Nephrology : JASN.

[30]  K. Bhaskaran,et al.  OpenSAFELY: factors associated with COVID-19 death in 17 million patients , 2020, Nature.

[31]  Beau B. Bruce,et al.  Characteristics Associated with Hospitalization Among Patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[32]  D. Nitsch,et al.  Epidemiology of COVID-19 in an Urban Dialysis Center. , 2020, Journal of the American Society of Nephrology : JASN.

[33]  M. Coco,et al.  Chronic Hemodialysis Patients Hospitalized with COVID-19: Short-term Outcomes in the Bronx, New York. , 2020, Kidney360.

[34]  Lei Liu,et al.  Epidemiological, Clinical, and Immunological Features of a Cluster of COVID-19–Contracted Hemodialysis Patients , 2020, Kidney International Reports.

[35]  David C Grabowski,et al.  Characteristics of U.S. Nursing Homes with COVID‐19 Cases , 2020, Journal of the American Geriatrics Society.

[36]  M. Zervos,et al.  Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit , 2020, JAMA network open.

[37]  L. Bowleg,et al.  We're Not All in This Together: On COVID-19, Intersectionality, and Structural Inequality. , 2020, American journal of public health.

[38]  A. Gharavi,et al.  Presentation and Outcomes of Patients with ESKD and COVID-19. , 2020, Journal of the American Society of Nephrology : JASN.

[39]  Shouzhi Fu,et al.  Clinical Features of Maintenance Hemodialysis Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. , 2020, Clinical journal of the American Society of Nephrology : CJASN.

[40]  Kai Shen,et al.  CovidNet: To Bring the Data Transparency in Era of COVID-19 , 2020, ArXiv.

[41]  V. Mor,et al.  Nursing Home Care in Crisis in the Wake of COVID-19. , 2020, JAMA.

[42]  X. Qi,et al.  High mortality rates for SARS-CoV-2 infection in patients with pre-existing chronic liver disease and cirrhosis: Preliminary results from an international registry , 2020, Journal of Hepatology.

[43]  D. Brodie,et al.  Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study , 2020, The Lancet.

[44]  Kenar D. Jhaveri,et al.  Acute kidney injury in patients hospitalized with COVID-19 , 2020, Kidney International.

[45]  Raj Bhopal,et al.  Sharpening the global focus on ethnicity and race in the time of COVID-19 , 2020, The Lancet.

[46]  Adolph Reed,et al.  Racial Health Disparities and Covid-19 - Caution and Context. , 2020, The New England journal of medicine.

[47]  K. Bibbins-Domingo,et al.  This Time Must Be Different: Disparities During the COVID-19 Pandemic , 2020, Annals of Internal Medicine.

[48]  M. Trabucchi,et al.  Nursing homes or besieged castles: COVID-19 in northern Italy , 2020, The Lancet Psychiatry.

[49]  Julia Raifman,et al.  Disparities in the Population at Risk of Severe Illness From COVID-19 by Race/Ethnicity and Income , 2020, American Journal of Preventive Medicine.

[50]  C. Laurencin,et al.  The COVID-19 Pandemic: a Call to Action to Identify and Address Racial and Ethnic Disparities , 2020, Journal of Racial and Ethnic Health Disparities.

[51]  Lynnette Brammer,et al.  Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[52]  R. Rubin.  Finding Ways to Reduce Coronavirus Exposure During Dialysis. , 2020, JAMA.

[53]  P. Davidson,et al.  Nursing homes and COVID‐19: We can and should do better , 2020, Journal of clinical nursing.

[54]  H. Rabb.  Kidney diseases in the time of COVID-19: major challenges to patient care. , 2020, The Journal of clinical investigation.

[55]  S. Merler,et al.  Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. , 2020, JAMA.

[56]  Faheem Ahmed,et al.  Why inequality could spread COVID-19 , 2020, The Lancet Public Health.

[57]  Huihui Ren,et al.  Clinical characteristics and outcomes of patients with severe covid-19 with diabetes , 2020, BMJ Open Diabetes Research & Care.

[58]  G. Lippi,et al.  Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection , 2020, International Urology and Nephrology.

[59]  Connie M. Rhee,et al.  A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease , 2020, American Journal of Nephrology.

[60]  T. Ikizler.  COVID-19 and Dialysis Units: What Do We Know Now and What Should We Do? , 2020, American Journal of Kidney Diseases.

[61]  A. Kliger,et al.  Mitigating Risk of COVID-19 in Dialysis Facilities. , 2020, Clinical journal of the American Society of Nephrology : CJASN.

[62]  Lei Dong,et al.  Kidney disease is associated with in-hospital death of patients with COVID-19 , 2020, Kidney International.

[63]  Michael Lawrence Barnett,et al.  Nursing Homes Are Ground Zero for COVID-19 Pandemic. , 2020, JAMA health forum.

[64]  Wei Wang,et al.  Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis , 2020, European Respiratory Journal.

[65]  S. Goto,et al.  Seasonal variations in cause-specific mortality and transition to renal replacement therapy among patients with end-stage renal disease , 2020, Scientific Reports.

[66]  K. Rothman,et al.  Excess Deaths Attributable to Influenza-Like Illness in the ESRD Population. , 2019, Journal of the American Society of Nephrology : JASN.

[67]  Connie M. Rhee,et al.  Seasonal variations in transition, mortality and kidney transplantation among patients with end-stage renal disease in the USA. , 2017, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[68]  Keith C. Norris,et al.  The relationship of age, race, and ethnicity with survival in dialysis patients. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[69]  Keith C. Norris,et al.  Racial survival paradox of dialysis patients: robust and resilient. , 2012, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[70]  Josef Coresh,et al.  Inflammation and the paradox of racial differences in dialysis survival. , 2011, Journal of the American Society of Nephrology : JASN.

[71]  K. Kalantar-Zadeh,et al.  Survival advantages of obesity in dialysis patients. , 2005, The American journal of clinical nutrition.

[72]  A. Salahudeen.  Obesity and survival on dialysis. , 2003, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[73]  N. Levin,et al.  Seasonal variations in mortality, clinical, and laboratory parameters in hemodialysis patients: a 5-year cohort study. , 2012, Clinical journal of the American Society of Nephrology : CJASN.