key: cord-0885467-8cemhh2v
authors: Andhika, Rizky; Huang, Ian; Wijaya, Indra
title: Severity of COVID‐19 in end‐stage kidney disease patients on chronic dialysis
date: 2020-10-27
journal: Ther Apher Dial
DOI: 10.1111/1744-9987.13597
sha: bf68bcdd5752b7b26c58ba38339e395a224d46af
doc_id: 885467
cord_uid: 8cemhh2v

nan

Dear Editor, There were some contentious issues concerning the severity of COVID-19 among end-stage kidney disease (ESKD) patients on chronic dialysis when an initial study reported a lesser severity of COVID-19 among those individuals. 1 To clarify this, we conducted a systematic review to explore the prevalence of severe COVID-19 and the mortality rate of COVID-19 among ESKD patients on chronic dialysis.

A literature search was performed of the electronic databases PubMed and the Cochrane Central Database, with the specific terms ("COVID-19" OR "SARS-CoV-2") AND ("ESKD" OR "End-Stage Kidney Disease" OR "End-Stage Renal Disease" OR "ESRD") AND ("Dialysis" OR "Hemodialysis"). A time restriction was applied from the date of inception to August 20, 2020, which was the date of our search finalization. All research articles in which the subjects were adult ESKD patients with COVID-19 on chronic dialysis were independently sorted, screened, and examined for relevance. Meta-analysis of proportion was conducted using MedCalc Statistical Software version 19.4.1 (MedCalc Software Ltd, Ostend, Belgium).

Overall, 381 publications were initially identified based on the search criteria and 26 articles were removed because of duplication. Then, of the remaining 355, 339 articles were excluded after title and abstract screening. After analyzing the remaining 16 full-text articles, six studies were removed because of the unavailability of data regarding severity or mortality of COVID-19 among ESKD patients on chronic dialysis. Finally, 10 articles were included in this analysis.

The characteristics of included studies are summarized in Table 1 . [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] The overall prevalence of COVID-19 among dialysis patients, rates of severe COVID-19 and mortality among hospitalized ESKD patients on chronic dialysis in this study were 18.4% (95% confidence interval [CI] 6.0-35.0, I 2 = 97.32%, P < .0001), 45.3% (95% CI 26.5-64.9, I 2 = 93.36%, P < .0001), and 26.8% (95% CI 19.2-35.1, I 2 = 67.74%, P = .0017), respectively. While the severity of COVID-19 was relatively similar across the globe, the mortality rate was strikingly lower in Asia (11.48%, 95% CI 4.8-20.4, I 2 = 0%, P = .5879), compared to Europe (39.1%, 95% CI 30.7-48.0, I 2 = 0%, P = .4565) and the United States (31.7%, 95% CI 27.6-35.9, I 2 = 0%, P = .8813).

Based on our study, we found that ESKD patients on dialysis are highly susceptible to contracting severe COVID-19 with a substantially increased risk of mortality compared to the general population across the globe. Hypothetically, this is due to immunocompromised state along with multiple comorbidities in this specific population. Interestingly, the in-hospital mortality rate in Asia was reported to be lower compared to Europe or the United States. While the definite causes of the disparity in the mortality rate in those geographical region are still unknown, several possible hypotheses are suggested, including mutational variants of SARS-CoV-2, genetic factors, body mass index, and other demographic factors. The initial data showing lower severity and mortality of COVID-19 among ESKD patients on chronic dialysis have misled many authors to believe that ESKD patients might have special characteristics which could reduce the severity of COVID-19. Our findings clarified this contentious issue and further confirmed the evidence for the utmost necessity of additional COVID-19 precautions in HD centers.

The authors declare no conflicts of interest.

The data used to support the findings of this study are included within the article. 

Epidemiological, clinical, and immunological features of a cluster of COVID-19-contracted hemodialysis patients

Presentation and outcomes of patients with ESKD and COVID-19

Chronic hemodialysis patients have better outcomes with COVID-19-A retrospective cohort study. medRxiv

Outcomes of patients with end-stage kidney disease hospitalized with COVID-19

COVID-19 outbreak in an urban hemodialysis unit

A report from the Brescia renal COVID task force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection

COVID-19: Clinical course and outcomes of 36 hemodialysis patients in Spain

COVID-19 outbreak in a hemodialysis center: A retrospective monocentric case series

Clinical characteristics of 31 hemodialysis patients with 2019 novel coronavirus: A retrospective study

Outcomes of COVID-19 among patients on in-center hemodialysis: An experience from the epicenter in South Korea

All the authors contributed equally to this study.

Rizky Andhika https://orcid.org/0000-0001-9599-3911 Ian Huang https://orcid.org/0000-0003-1189-8453 Indra Wijaya https://orcid.org/0000-0002-9446-2307