Abstract
Hemodialysis (HD) patients are highly susceptible to COVID-19 infection. However, comprehensive assessments of current evidence regarding COVID-19 in HD patients remain incomplete. We systematically searched PUBMED and EMBASE for articles published on incidence or mortality of COVID-19 infection in HD patients until September 2020. Two independent researchers extracted data and study-level risk of bias across studies. We conducted meta-analysis of proportions for incidence and mortality rate. Study heterogeneity and publication bias were assessed. A total of 29 articles with 3261 confirmed COVID-19 cases from a pool of 396,062 HD patients were identified. Incidence of COVID-19 in these HD patients was 7.7% (95% CI: 5.0–10.9%; study heterogeneity: I2 = 99.7%, p < 0.001; risk of publication bias, Egger’s test, p < 0.001). Overall mortality rate was 22.4% (95% CI: 17.9–27.1%; study heterogeneity: I2 = 87.1%, p < 0.001; risk of publication bias, Egger’s test: p = 0.197) in HD patients with COVID-19. Reported estimates were higher in non-Asian than Asian countries. Quality of study may affect the reported incidence but not the mortality among studies. Both incidence and mortality of COVID-19 infection were higher in HD patients. Available data may underestimate the real incidence of infection. International collaboration and standardized reporting of epidemiological data should be needed for further studies.
Highlights
The novel coronavirus, COVID-19, continues to generate a tremendous global burden with 62,363,527 confirmed cases and 1,456,687 deaths worldwide, as of the end of November2020 [1]
Cohorts (Asian countries: 47.8%; good study quality: 43.5%) for assessment of incidence and 27 HD cohorts (Asian countries: 42.9%; good study quality: 35.7%) for analysis of mortality related to COVID-19 infection (Table 2)
We found that the incidence of COVID-19 infection in patients receiving HD therapy was 7.7%, but there was evidence of statistical heterogeneity among the studies (I2 = 99.7%, p < 0.001) (Figure 2)
Summary
The novel coronavirus, COVID-19, continues to generate a tremendous global burden with 62,363,527 confirmed cases and 1,456,687 deaths worldwide, as of the end of November2020 [1]. The novel coronavirus, COVID-19, continues to generate a tremendous global burden with 62,363,527 confirmed cases and 1,456,687 deaths worldwide, as of the end of November. Many risk factors related to the incidence of COVID-19 infection have been identified; for example, advanced age, diabetes mellitus, hypertension and smoking [2,3]. Higher risks of mortality caused by COVID-19 are found in patients with older age, more comorbidities, and immune dysfunction [3,4]. A comprehensive assessment of published literature with regard to the epidemiology in patients with renal impairment infected by COVID-19 remains scarce. The prevalence of chronic kidney disease (CKD) is about 9.1% worldwide [5], and end-stage renal disease (ESRD) is associated with higher comorbidity, mortality risks, and socioeconomic impacts, affecting 2,859,750 patients globally [6]. In-center hemodialysis (HD) is the predominant renal replacement modality across different countries, except in
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