Mortality in patients on dialyses and kidney transplant recipients during pandemic
Jolanta Malyszko1, Pawel Zebrowski 1, Ewa Wojtaszek 1, Urszula Oldakowska-Jedynak 1, Tadeusz Grochowiecki2, Slawomir Nazarewski 2.
1Nephrology, Dialysis and Internal Medicine, Warsaw Medical University , Warsaw, Poland; 2General, Vascular and Transplant Surgery, Warsaw Medical University , Warsaw, Poland
Introduction: Novel coronavirus disease (COVID-19) is a newly discovered contagious disease caused by SARS-CoV-2 virus, primarily manifesting as an acute respiratory illness with pneumonia, but can affect multiple organs such as kidney, heart, digestive tract, blood and nervous system. Patients with end-stage kidney disease undergoing dialysis or kidney transplant recipients are particularly vulnerable to severe COVID-19 due to the older age and high frequency of comorbidity, such as diabetes and hypertension, in this population. Reported mortality is higher than usual annual mortality and is associated with older age and number of comorbidities. Despite two years of pandemia data are still limited in relation to three modalities of renal replacement therapy in Poland.
Methods: Retrospectively collected data in single university hospital on hemodialysis, peritoneal dialysis and kidney transplant recipients engrafted during pandemia. We viewed epidemiologic and clinical data of patients with laboratory-confirmed COVID-19 and assess mortality in 2019, and 2020 and 2021.
Results: Unadjusted mortality in dialyzed patients (number of deaths divided by number of patients) in 2019 was 19%, while unadjusted (after exclusion of COVID-related deaths) mortality in 2020 was 21%, in 2021 mortality was 25%. The prevalence of cardiovascular deaths in 2019 and 2020 and 2021 was almost identical (41 vs 41 vs 42%). In kidney transplant recipients mortality in 2019 was 3%, in 2020 was 3% (COVID-19 related) and in 2021 was 7% (all COVID19 related). Mortality of COVID-19 positive dialyzed patients contributed to the 24% of all recorded deaths.
Conclusions: Patients receiving maintenance hemodialysis were susceptible to COVID-19 and that hemodialysis centers were high- risk settings during the epidemic. However, changes in the HD schemes due to necessity to isolate COVID-19 positive patients, shortened dialyses did not change significantly of the cardiovascular mortality in dialyzed population. COVID-19 is a huge challenge and danger for dialyzed population. Kidney transplant recipients despite immunosuppression were less vulnerable.
