Mortality and risk factors for COVID-19 in hemodialysis patients: A systematic review and meta-analysis

• Published in: Science progress (1916) 2022-07, Vol.105 (3), p.368504221110858
• Main Authors: Li, Pulin, Guan, Youhong, Zhou, Sijing, Wang, Enze, Sun, Peng, Fei, Guanghe, Zeng, Daxiong, Wang, Ran
• Format: Article
• Language: English
• Subjects: Asymptomatic; Cardiovascular disease; Chronic obstructive pulmonary disease; Confidence intervals; Coronary artery; Coronary artery disease; Coronaviruses; Cough; COVID-19; COVID-19 - epidemiology; Fever; Health risks; Heart diseases; Hemodialysis; Heterogeneity; Humans; Lung diseases; Male; Males; Meta-analysis; Mortality; Mortality risk; Obstructive lung disease; Original Manuscript; Patients; Renal Dialysis; Respiratory diseases; Risk analysis; Risk Factors; SARS-CoV-2; Signs and symptoms; Statistical analysis; Subgroups; Viral diseases
• ISSN: 0036-8504; 2047-7163
• DOI: 10.1177/00368504221110858

Introduction: The present study systematically reviewed the clinical features and risk factors in patients undergoing maintenance hemodialysis (MHD) who also acquired coronavirus disease 2019 (COVID-19). More specifically, clinical manifestations, prognosis, and risk factors for death among this population were explored. Method: A literature search using the PubMed, Web of Science, and Embase databases, for articles involving patients with laboratory-confirmed COVID-19 and undergoing MHD published between January 1, 2020, and March 13, 2022, was performed. Random-effects meta-analyses were performed to calculate the weighted mean prevalence and corresponding 95% confidence interval (CI) or weighted means and 95% CI. Heterogeneity among studies was assessed using I2 statistics. Results: Twenty-two studies including 13,191 patients with COVID-19 undergoing MHD were selected. The most common symptoms included fever (53% [95% CI 41%–65%]) and cough (54% [95% CI 48%-60%]); however, 17% (95% CI 11%–22%) of the cases were asymptomatic. In subgroup analysis, the proportion of male patients (65% [95% CI 58%–71%]), and patients with coronary artery disease (30% [95% CI 17%–44%) and chronic obstructive pulmonary disease (9% [95% CI 4%–15%]) was greater in the non-survivor group compared with the survivor group. Furthermore, patients undergoing MHD, who were also positive for COVID-19, exhibited a high mortality rate (24% [95% CI 19%–28%]). Conclusions: MHD patients with COVID-19 may initially present as asymptomatic or with mild symptoms; nevertheless, in this study, these patients exhibited a higher risk for death compared with COVID-19 patients not undergoing MHD. Moreover, male sex and underlying cardiovascular and respiratory diseases increased the mortality risk.