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Abstract: PO0729

Factors Associated with SARS-CoV-2 Infection (COVID) Severity and Mortality in Chronic Dialysis Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Aweh, Gideon N., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Ladik, Vladimir, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Manley, Harold J., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Stewart, Carol, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Johnson, Doug, Dialysis Clinic Inc, Nashville, Tennessee, United States
Background

From 2/17 to 5/29, 2020, Dialysis Clinic Inc. had 422 maintenance dialysis patients diagnosed with COVID from 90 clinics in 20 states. While prognostic factors in the general population have been reported, there is limited information regarding the US dialysis population.

Methods

Over a 15 week period of observation, 96 patients died (22.7%) and 116 (27.5%) were not hospitalized (for up to 30 days post-COVID diagnosis), likely with milder illness. We compiled univariable associations with p<0.1 into stepwise logistic regression models (forcing in age, sex. race) to determine factors associated with 1) Death from COVID; and 2) Moderate/severe illness (hospitalized or died without hospitalization <30 days post-COVID diagnosis).

Results

Candidate variables are listed in the table, with retained significant factors marked (a or b at p<0.05). Notably, 42% of all deaths occurred at age >75 years, increasing to 74% of all deaths at age >65 years. Wheelchair use also associated with higher death risk.

Conclusion

Dialysis patients with low albumin and vintage ≧1 year associated with increased illness severity. It was surprising that a history of pneumonia vaccine associated with more severe illness - whether this reflects "treatment by indication" bias vs. pulmonary immune activation by vaccination vs. chance finding is unclear. PVD also tended to increase illness severity but more importantly, was significantly associated with risk of death, independent of older age.

Each Model Total N=422COVID SeverityCOVID Death
Model Entry VariablesMod/Severe
(N=306)
Mild Disease
(N=116)
Died
(N=96)
Alive
(N=326)
Mean Age (years)65.564.171.1a63.4
% Male62.155.263.559.2
% White26.126.736.5b23.3
% Black56.956.946.959.8
% Other Race17.016.416.716.9
% Vintage ≥1 year84.0a70.7
% Albumin <3.5 g/dL22.2a11.227.116.9
% Pneumonia Vaccine85.0b72.4
% ACE-Inh/ARBs21.933.7
% Wheelchair4.60.97.4b2.6
# Comorbidities3.42.93.83.1
% CHF31.320.6
% Other CVD45.834.4
% PVD17.6b9.525.0a12.6

a: Significant in the multivariable model; b: Significant if age, sex, and/or race were not forced into the model.