Extremely high mortality in COVID-19 hemodialyzed patients in before anty-SARS-CoV-2 vaccination era. The first large database from Poland.

Abstract

INTRODUCTION\nPreliminary reports suggest a high incidence and mortality with SARS-CoV-2 infection in patients receiving kidney replacement therapy.\n\n\nOBJECTIVES\nTo describe the incidence and outcomes of COVID-19 in hemodialyzed (HD) patients.\n\n\nPATIENTS AND METHODS\nWe conducted a cohort, retrospective, multicenter study on incidence and mortality of COVID-19 in HD patients compared to the adult general population from the beginning of the pandemic until the commencement of vaccination against SARS-CoV-2 infection. The study population included all prevalent HD patients in 14 dialysis units of the Pomeranian Voivodeship, Poland on December 31, 2019 and all new subjects starting long-term hemodialysis between January 01, 2020 and January 31, 2021, 1567 patients in total. General population data was obtained from health authorities reports.\n\n\nRESULTS\nThe absolute cumulative incidence of SARS-CoV-2 infection was 22.4% in HD patients and after age standardization was 3.98 times higher compared to the controls (P<0.001). The epidemic trajectory of both groups ran in parallel, but the increase and the decline in the number of new cases occurred earlier in HD patients. Fatality rate of COVID-19 was 30.4% in HD patients. It was highest among the oldest patients reaching 43.81% among subjects from the age 75 years (P=0.003). Age standardized fatality and mortality rates in HD patients were 5.5 and 10.9 times higher than in controls (both: P<0.001).\n\n\nCONCLUSIONS\nThe results of this study show the extremely high mortality of COVID-19 in HD patients during the first and second wave of the epidemic in the Pomeranian Voivodeship before the vaccination era.