Canadian study shows higher mortality rate among patients on dialysis who have COVID-19
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Patients on dialysis in Ontario, Canada, are almost four times more likely to die from COVID-19 than patients without kidney disease, researchers said in a new study.
“As the COVID-19 pandemic proceeds, focused efforts should be made to protect this population from infection including prioritizing patients on long-term dialysis and the staff treating them for SARS-CoV-2 vaccination,” Peter Blake, MD, provincial director, Ontario Renal Network, Ontario Health, and professor, Schulich School of Medicine and Dentistry, Western University, London, Ontario, and colleagues wrote in their study.
Ontario is the largest province by population in Canada, “and almost 41,000 people had tested positive” for the virus by August 2020, the authors wrote. That represented 0.3% of the city’s population. “Close to 2,800 people had died, a case fatality rate of 6.8%,” they wrote.
The researchers reviewed data on patients on dialysis ( n = 12,501) in Ontario between March 12, 2020 and Aug. 20, 2020, of whom 187 (1.5%) were diagnosed with the SARS-CoV-2 infection.
Of these, 53 people (28.3%) died and 117 (62.6%) were admitted to the hospital.
In contrast, uninfected people who were on dialysis during that period had a mortality rate of 5.8% and a hospitalization rate of 27%, the researchers wrote.
“Patients undergoing dialysis have high rates of comorbid conditions, are often older adults, have varying degrees of immunosuppression and are more likely to reside in long-term care, which puts them at risk of both acquiring SARS-CoV-2 and developing complicated disease,” the researchers wrote. “Furthermore, in Ontario, those who receive in-center hemodialysis typically have [three] treatments per week in outpatient units located in or affiliated with hospitals, and the consequent inability to fully self-isolate means that patients undergoing hemodialysis likely have an even higher risk of SARS-CoV-2 infection.”
In an interview with Healio Nephrology, Blake said the mortality rate has slowed among patients on dialysis with the virus since the study was published but remains high. “Our data in the paper only goes to the end of August 2020,” Blake said. “As of Feb. 1, we are up to almost 5% of all dialysis patients having had COVID-19 in Ontario with mortality of 21% vs. the 28% we describe in the first wave. That is still horribly high.”
The study also showed patients on in-center dialysis had infection rates 2.5 times higher than patients on home dialysis.
Even with improved surveillance, access to COVID-19 vaccines remains a problem in Canada and patients on dialysis are not a high priority, Blake said.
“We are behind the United States and way behind the United Kingdom in getting people vaccinated. Priority has so far been given to [long-term care] LTC residents and staff as death rates have been very high in LTC facilities,” Blake said.
“High risk, frontline workers, including nurses and physicians in the ICU, COVID wards, emergency rooms and most renal clinics are getting vaccinated in Toronto and most of Southern Ontario ... Dialysis patients sadly are not so far being prioritized but likely will be in the next wave of vaccination,” he said. “This is why this paper is so important.”
Almost 80% of deaths recorded in the study occurred in eight of the 27 renal programs in Ontario. “If you live in Toronto there is 3.2 times the risk of contracting COVID-19,” Blake said. “That is likely due to the density of living, areas of socioeconomic deprivation and more varied ethnicities.”
The researchers advised that in addition to vaccination and infection precautions, “prevention strategies should include specific education of these patients about their risk of infection and associated high mortality,” the researchers wrote. “Paid sick leave for those patients who are required to work in risk-associated occupations should be provided. Other strategies should include a low symptom threshold for testing, increased space between treatment stations within hemodialysis units, universal droplet precautions, as well as regular surveillance testing of high-risk groups such as people living in long-term care. Encouragement of suitable patients to start home dialysis because of a lower infection risk has been reinforced and strategies to provide on-site dialysis in long-term care facilities are being developed,” the researchers wrote.
References:
Taji L, et al. CMAJ.2021;doi:10.1503/cmaj.202601
www.eurekalert.org/pub_releases/2021-02/cmaj-dph020421.php
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