Dialysis parameters associated with SARS-CoV-2 infection and prognosis in end-stage kidney disease

• Published in: Annals of medicine (Helsinki) 2024-12, Vol.56 (1), p.2343890-2343890
• Main Authors: Bezerra, Rodrigo, Feitosa, Audes D M, Silvestre, Odilson M, Fernandes-Silva, Miguel M, Amazonas, Roberto B, Teles, Flavio, Rodrigues, Cibele I S, Lima-Filho, Jose L, Sposito, Andrei C, Nadruz, Jr, Wilson
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Pressure; Brazil - epidemiology; chronic kidney failure; Covid-19; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - mortality; COVID-19 - therapy; Female; hemodialysis; Hospitalization - statistics & numerical data; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Male; Middle Aged; mortality; Prognosis; Renal Dialysis - statistics & numerical data; Retrospective Studies; SARS-CoV-2
• ISSN: 0785-3890; 1365-2060
• DOI: 10.1080/07853890.2024.2343890

The Covid-19 pandemic has affected patients with end-stage kidney disease (ESKD). Whether dialysis parameters have a prognostic value in ESKD patients with Covid-19 remains unclear. We retrospectively evaluated clinical characteristics, blood pressure (BP) and dialysis parameters in ESKD patients undergoing maintenance outpatient hemodialysis, with (Covid-ESKD) and without (No-Covid-ESKD) Covid-19, at four Brazilian hemodialysis facilities. The Covid-ESKD (  = 107; 54% females; 60.8 ± 17.7 years) and No-Covid-ESKD (  = 107; 62% females; 58.4 ± 14.6 years) groups were matched by calendar time. The average BP and dialysis parameters were calculated during the pre-infection, acute infection, and post-infection periods. The main outcomes were Covid-19 hospitalization and all-cause mortality. Covid-ESKD patients had greater intradialytic and postdialysis systolic BP and lower predialysis weight, postdialysis weight, ultrafiltration rate, and interdialytic weight gain during acute-illness compared to 1-week-before-illness, while these changes were not observed in No-Covid-ESKD patients. After 286 days of follow-up (range, 276-591), there were 18 Covid-19-related hospitalizations and 28 deaths among Covid-ESKD patients. Multivariable logistic regression analysis showed that increases in predialysis systolic BP from 1-week-before-illness to acute-illness (OR, 95%CI = 1.06, 1.02-1.10;  = .004) and Covid-19 vaccination (OR, 95%CI = 0.16, 0.04-0.69;  = .014) were associated with hospitalization in Covid-ESKD patients. Multivariable Cox-regression analysis showed that Covid-19-related hospitalization (HR, 95%CI = 5.17, 2.07-12.96;