Abstract: PO0729
Factors Associated with SARS-CoV-2 Infection (COVID) Severity and Mortality in Chronic Dialysis Patients
Session Information
- COVID-19: Dialysis Patients
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
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=422 | COVID Severity | COVID Death | ||
| Model Entry Variables | Mod/Severe (N=306) | Mild Disease (N=116) | Died (N=96) | Alive (N=326) |
| Mean Age (years) | 65.5 | 64.1 | 71.1a | 63.4 |
| % Male | 62.1 | 55.2 | 63.5 | 59.2 |
| % White | 26.1 | 26.7 | 36.5b | 23.3 |
| % Black | 56.9 | 56.9 | 46.9 | 59.8 |
| % Other Race | 17.0 | 16.4 | 16.7 | 16.9 |
| % Vintage ≥1 year | 84.0a | 70.7 | ■ | ■ |
| % Albumin <3.5 g/dL | 22.2a | 11.2 | 27.1 | 16.9 |
| % Pneumonia Vaccine | 85.0b | 72.4 | ■ | ■ |
| % ACE-Inh/ARBs | ■ | ■ | 21.9 | 33.7 |
| % Wheelchair | 4.6 | 0.9 | 7.4b | 2.6 |
| # Comorbidities | 3.4 | 2.9 | 3.8 | 3.1 |
| % CHF | ■ | ■ | 31.3 | 20.6 |
| % Other CVD | ■ | ■ | 45.8 | 34.4 |
| % PVD | 17.6b | 9.5 | 25.0a | 12.6 |
a: Significant in the multivariable model; b: Significant if age, sex, and/or race were not forced into the model.