Mortality in Hemodialysis Patients with COVID-19, the Effect of Paricalcitol or Calcimimetics.

Julio Pascual,José Jesús Broseta ,Rosa Ramos,Marta Crespo,Carlos Soto Montañez,Marta Riera,Francesc Barbosa,Vicenç Torregrosa ,Juan F Navarro‐González ,Sara Hurtado,Emilio González‐Parra ,Adriana Dusso ,María Dolores Arenas Jiménez ,Ana López‐Herradón ,Xavier Nogués ,Laura Badenes Ribera ,Higini Cao,Sílvia Collado ,Jordi Bover,Fabiola Dapena,Abraham Rincón Bello

doi:10.3390/nu13082559

Abstract

Background. In COVID-19 patients, low serum vitamin D (VD) levels have been associated with severe acute respiratory failure and poor prognosis. In regular hemodialysis (HD) patients, there is VD deficiency and markedly reduced calcitriol levels, which may predispose them to worse outcomes of COVID-19 infection. Some hemodialysis patients receive treatment with drugs for secondary hyperparathyroidism, which have well known pleiotropic effects beyond mineral metabolism. The aim of this study was to evaluate the impact of VD status and the administration of active vitamin D medications, used to treat secondary hyperparathyroidism, on survival in a cohort of COVID-19 positive HD patients. Methods. A cross-sectional retrospective observational study was conducted from 12 March to 21 May 2020 in 288 HD patients with positive PCR for SARS-CoV2. Patients were from 52 different centers in Spain. Results. The percent of HD patients with COVID-19 was 6.1% (288 out of 4743). Mortality rate was 28.4% (81/285). Three patients were lost to follow-up. Serum 25(OH)D (calcidiol) level was 17.1 [10.6–27.5] ng/mL and was not significantly associated to mortality (OR 0.99 (0.97–1.01), p = 0.4). Patients receiving active vitamin D medications (16/94 (17%) vs. 65/191(34%), p = 0.003), including calcimimetics (4/49 (8.2%) vs. 77/236 (32.6%), p = 0.001), paricalcitol or calcimimetics (19/117 (16.2%) vs. 62/168 (36.9%); p < 0.001), and also those on both paricalcitol and calcimimetics, to treat secondary hyperparathyroidism (SHPTH) (1/26 (3.8%) vs. 80/259 (30.9%), p < 0.001) showed a lower mortality rate than patients receiving no treatment with either drug. Multivariate Cox regression analysis confirmed this increased survival. Conclusions. Our findings suggest that the use of paricalcitol, calcimimetics or the combination of both, seem to be associated with the improvement of survival in HD patients with COVID-19. No correlation was found between serum VD levels and prognosis or outcomes in HD patients with COVID-19. Prospective studies and clinical trials are needed to support these findings.

Highlights

The world is experiencing its third major epidemic of coronavirus (CoV) infection [1].A new coronavirus-induced pneumonia, which appeared in late November 2019 in Wuhan, China, was named coronavirus 2019 disease (COVID-19) by the World Health Organization (WHO) on 11 February 2020 [2]
Based on the sample size and the number of events, variables significantly related with mortality in univariate analyses were prioritized and included in a multivariate Cox model to obtain the corresponding hazard ratios (HRs) and 95% confidence intervals (CIs)
COVID-19 was diagnosed through a positive RT-PCR test for SARS-CoV-2 in 288 out of 4743 HD patients (6.1%)

Summary

Introduction

The world is experiencing its third major epidemic of coronavirus (CoV) infection [1].A new coronavirus-induced pneumonia, which appeared in late November 2019 in Wuhan, China, was named coronavirus 2019 disease (COVID-19) by the World Health Organization (WHO) on 11 February 2020 [2]. In COVID-19 patients, low serum vitamin D (VD) levels have been associated with severe acute respiratory failure and poor prognosis. The aim of this study was to evaluate the impact of VD status and the administration of active vitamin D medications, used to treat secondary hyperparathyroidism, on survival in a cohort of COVID-19 positive HD patients. Patients receiving active vitamin D medications (16/94 (17%) vs 65/191(34%), p = 0.003), including calcimimetics (4/49 (8.2%) vs 77/236 (32.6%), p = 0.001), paricalcitol or calcimimetics (19/117 (16.2%) vs 62/168 (36.9%); p < 0.001), and those on both paricalcitol and calcimimetics, to treat secondary hyperparathyroidism (SHPTH) (1/26 (3.8%) vs 80/259 (30.9%), p < 0.001) showed a lower mortality rate than patients receiving no treatment with either drug.

Objectives

Methods

Results