#5019 MORTALITY FOR COVID-19 IN UNDERGOING MAINTENANCE DIALYSIS PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Abstract Background and Aims Since December 2019, patients undergoing maintenance dialysis have been significantly affected by COVID-19, facing higher risk of death than general population. However, current evidences assess the mortality of patients with COVID-19 remains incomplete. We performed meta-analyses of overall mortality in dialysis patients after SARS-CoV-2 infection. In addition, this study investigated the differences among different races,viral variants, hemodialysis and peritoneal dialysis with COVID-19. At the same time, the mortality rate of dialysis patients with the COVID-19 after vaccination was also observed. Method We performed a meta-analysis with literature searching in PubMed, EMBASE, Web of Science and Cochrane databases, published between December 1, 2019 and January 10,2023. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. Fixed effects model and random effects model were used for calculating heterogeneity. Results A total of 83 studies included 7278 died from confirmed COVID-19 cases in a pool of 42925 dialysis patients. Overall mortality of COVID-19 in dialysis patients was 22% (95%Confidence Interval [CI]:19%-25%, p<0.01; I2 = 96.74%) from 2020 to 2022. In subgroup analysis, compared with ancestral COVID-19 (23%,95%CI:20%-25%,p<0.01; I2 = 93.01%) and alpha variant (30%, 95% CI:21%-54%,p<0.01;I2 = 95.35%),omicron variant (4%,95%CI:0-14%,p = 0.09; I2 = 0) had a lower morality significantly (Figure 1). The mortality for Asian and non-Asian were 20% (95% CI:16%-25%,p<0.01;I2 = 96.6%) and 24% (95%CI:20%-27%,p<0.01; I2 = 96.32%) respectively. The odds of death for maintenance hemodialysis and peritoneal dialysis were similar (odd ratio [OR] 1.30,95%CI:0.88-1.93,p = 0.191,I2 = 0). Furthermore, we also compared vaccination with unvaccination, and found out that vaccination was associated with lower mortality (OR = 0.18, 95%CI:0.11-0.28,p<0.01;I2 = 71.4%) (Figure 2). Conclusion Patients undergoing maintenance dialysis with COVID-19 have a higher morality. These findings suggest that the mortality of omicron variant may be lower than other variants. In our study, there's no significant difference in mortality between hemodialysis and peritoneal dialysis patients with COVID-19. Moreover, vaccines have a good protective effect on dialysis patients.