COVID-19 mortality alarmingly high in dialysis patients

Researchers in Spain have found in a new study that mortality among hospitalized dialysis patients diagnosed with COVID-19 infection is strikingly high. Several laboratory parameters at day 7 after hospital admission could be used to assess the clinical outcome of these patients.

At the Opening Conference of the ERA-EDTA Congress, Dr. Maria Jose Soler Romeo presented data gathered at the Hospital Vall d'Hebron. Of 400 dialysis patients with the Vall d´Hebron as a reference hospital, 21 or a good 5% had COVID-19. In the whole of Spain, 238,000 out of 47 million people (about 0.5%) had contracted the disease at that time. The figures obtained from the Hospital Vall d'Hebron on the incidence of COVID-19 are not representative, of course, as it is only one center, but they do indicate a significantly higher rate of infection for dialysis patients. Of the 21 dialysis patients who contracted COVID-19, 15 were discharged, one was on the ICU at the time of the survey, and five had died. The mortality rate in this center was 24%.

This high death rate among infected dialysis patients was also verified in an analysis of the Spanish COVID-19 Dialysis/Transplantation Registry, which included a total of 1572 ESRD patients, including 998 HD patients, 51 PD patients and 523 kidney transplant patients. The mortality rate among HD patients was more than 27% for the whole Spain, but was also more than 23% for kidney transplant patients. PD patients had a significantly lower mortality rate of 15%, but their number is so small in proportion that it is almost impossible to make statistically valid statements about this patient group.

The high mortality rate among dialysis patients was also verified in a study that monitored the course of disease in 36 HD patients between March 12 and April 10 in Hospital Gregorio Marañón in Madrid. The death rate here was as high as 30.5%, but what is particularly interesting about this study is that it analyzed predictors of mortality. The conclusion was that, in addition to patient older age and pneumonia, there are three factors that significantly influence the mortality rate among coronavirus-positive dialysis patients: (1) the number of years on dialysis (dialysis vintage), (2) lymphopenia, which describes a low number of special white blood cells (lymphocytes) that protect the body from infections, and (3) elevated LDH levels, a surrogate for tissue damage.

"What we had to learn from nephrologists in Spain is that dialysis patients are more susceptible to the virus and that the risk of patients dying is very high at a rate of 1:4. These patients need special protection. Many studies have shown that even people without symptoms or with asymptomatic symptoms can carry and pass on the virus. In dialysis units, therefore, we cannot rely on always being able to detect infected patients and to isolate them in time. To protect our highly vulnerable patients, it is essential that all the patients and staff be tested on a regular basis in order to minimize the risk of infection in COVID-19 outbreaks. We must continually remind ourselves that, of four coronavirus-positive dialysis patients, one will not survive. Outbreaks in dialysis units must therefore be prevented at all costs", Dr. Soler concluded.