SARS-CoV-2 Infection in Patients on Dialysis: Incidence and Outcomes in the Lazio Region, Italy.

Claudia Marino,Silvia Cascini,Nicola Petrosillo,Anteo Di Napoli,Anna Maria Bargagli,Laura Angelici,Valentina Pistolesi,Marina Davoli,Santo Morabito,Nera Agabiti,Enrico Calandrini

doi:10.3390/jcm10245818

Claudia Marino, Silvia Cascini + Show 9 more

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https://doi.org/10.3390/jcm10245818

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Abstract

Patients with end-stage kidney disease represent a frail population and might be at higher risk of SARS-CoV-2 infection. The Lazio Regional Dialysis and Transplant Registry collected information on dialysis patients with a positive swab. The study investigated incidence of SARS-CoV-2 infection, mortality and their potential associated factors in patients undergoing maintenance hemodialysis (MHD) in the Lazio region. Method: The occurrence of infection was assessed among MHD patients included in the RRDTL from 1 March to 30 November 2020. The adjusted cumulative incidence of infection and mortality risk within 30 days of infection onset were estimated. Logistic and Cox regression models were applied to identify factors associated with infection and mortality, respectively. Results: The MHD cohort counted 4942 patients; 256 (5.2%) had COVID-19. The adjusted cumulative incidence was 5.1%. Factors associated with infection included: being born abroad, educational level, cystic renal disease/familial nephropathy, vascular disease and being treated in a dialysis center located in Local Health Authority (LHA) Rome 2. Among infected patients, 59 (23.0%) died within 30 days; the adjusted mortality risk was 21.0%. Factors associated with 30-day mortality included: age, malnutrition and fever at the time of swab. Conclusions: Factors associated with infection seem to reflect socioeconomic conditions. Factors associated with mortality, in addition to age, are related to clinical characteristics and symptoms at the time of swab.

Highlights

A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), causing coronavirus disease 2019 (COVID-19), appeared in late 2019 in Wuhan, China, and rapidly spread progressively to other countries [1,2,3], with the WHO declaring it a pandemic and public health emergency of international concern in March 2020 [4]
The “RRDTL COVID-19 section” identified 222 patients with a positive SARSCoV-2 swab; among them, one could not be searched in the platform since he did not have an anonymous code, 195 (88%) were found in the regional platform and 26 (12%)
Regarding the impact of COVID-19 on the maintenance hemodialysis (MHD) population, a national survey conducted by the Italian Society of Nephrology during the first wave of the COVID-19 pandemic (April 2020), which considered data from 80.4% of Italian nephrology centers, reported a proportion of 3.55% of MHD patients to be positive for SARS-CoV-2 [54]

Summary

Introduction

A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), causing coronavirus disease 2019 (COVID-19), appeared in late 2019 in Wuhan, China, and rapidly spread progressively to other countries [1,2,3], with the WHO declaring it a pandemic and public health emergency of international concern in March 2020 [4]. 2,107,166 cumulative cases and 74,159 deaths [5]. COVID-19 primarily manifests itself as an acute upper and lower respiratory tract illness that may be complicated by interstitial and alveolar pneumonia. It may affect multiple other tissues such as the heart, digestive tract, kidneys, blood and nervous system [7,8,9]. According to the published literature, older patients with underlying chronic conditions such as diabetes mellitus, hypertension and cardiovascular disease tend to be more susceptible to COVID-19 and become severely ill [10]. COVID-19 has caused a significant increase in the number of hospitalizations and intensive care unit admissions, with well-investigated pulmonary, cardiac, vascular and renal complications [11,12,13,14,15]

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