Narayan Prasad1, Manas Ranjan Behera1, Mansi Bhatt1, Sanjay Kumar Agarwal2, N Gopalakrishnan3, Edwin Fernando4, Arpita Roy Chaudhary5, Manisha Sahay6, Shivendra Singh7, Apoorva Jain8, Shruti Tapiawala9, Aniket Kamble10, Umesh Khanna10, Rubina Bohra11, Anurag Gupta12, Urmila Anandh13, Vivekanand Jha14. 1. Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. 2. All India Institute of Medical Sciences, New Delhi, India. 3. Madras Medical College, Chennai, India. 4. Stanley Medical College, Chennai, India. 5. Postgraduate Institute of Medical Education and Research, Kolkata, India. 6. Osmania General Hospital, Hyderabad, India. 7. Institute of Medical Sciences, BHU, Varanasi, India. 8. Sarojini Naidu Medical College, Agra, India. 9. Global Hospital, Mumbai, India. 10. Lancelot Kidney Hospital, Mumbai, India. 11. Shri Aurobindo Medical College and Postgraduate Institute, Indore, India. 12. Sir Ganga Ram Hospital, New Delhi, India. 13. Yashoda Hospital, Hyderabad, India. 14. George Institute India, University of New South Wales, Sydney, New South Wales, Australia.
Abstract
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.
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.