MO857: COVID-19 in Moscow Region Among HD Patients: Results of a Population Cross-Sectional Study
Authors: Zulkarnaev Aleksei , Vatazin Andrey , Stepanov Vadim 
Published: May 2022

Abstract

BACKGROUND AND AIMS
We aimed to analyze the outcomes of HD patients with COVID-19 hospitalized in the Moscow region, Russia, and to compare it with those in the general population.

METHOD
Data were obtained retrospectively from the Moscow region COVID-19 register database, which comprises all hospitalizations with suspected or confirmed COVID-19 between February 2020 and November 2021. A total of 384 327 patients were included; 1 435 of them were ESRD patients.

RESULTS
Among ESRD patients there were 1386 HD patients and 49 kidney graft recipients.
Thus, during the specified period, 48.5% of all prevalent HD patients of the Moscow region and only 7.8% of the graft recipients required hospitalization. Due to a few number of hospital admissions among kidney recipients they were excluded from the further analyses.
We observed typical 4 waves of hospital admissions in the general population, but not in HD patients. In these patients, we noted a peak in December 2020 with a subsequent decrease in February, 2021; then the number of hospitalizations remained stable. The proportion of HD patients was approximately 0.5% of all patients with COVID-19 admitted to hospital. Almost all HD patients with COVID-19 were hospitalized regardless of disease severity.
The mean age of hospitalized HD patients was significantly more than that in the general population: 68.95 ± 13.69 years versus 59.18 ± 17.11 years, P &lt; 0.001. Of note, the mean age of HD patients in Russia is 56.3 ± 11.7 years. The proportion of men among hospitalized HD patients with COVID-19 reached 50.4% versus 43.5% in the general population.
HD was associated with a significant increase in the risk of critical but stable and extremely critical (+ worsened: terminal and clinical death) condition at admission (Figure 1A): RR = 3.36 [95% confidence interval (95% CI) 3.12–3.59], P &lt; 0.001 and RR = 4.83 (95% CI 3.93–5.92), P &lt; 0.001, respectively.
HD patients were significantly more likely to need for any kind of respiratory support (oxygen mask and mechanical ventilation (MV)) or MV alone (Figure 1B): RR = 1.72 (95% CI 1.63–1.81), P &lt; 0.001 and RR = 4.67 (95% CI 4.18–5.21), P &lt; 0.001, respectively.
HD was associated with a significant increase in the risk of death (Figure 1C): RR = 3.48 (95% CI 3.24–3.72), P &lt; 0.001.
HD significantly increased the risk of death in patients without oxygen support and in patients with need for an oxygen mask (Figure 2A): RR = 3.56 (95% CI 2.97–4.25), P &lt; 0.001 and RR = 2.47 (95% CI 2.18–2.78), P &lt; 0.001, respectively. For patients requiring MV, mortality was &gt;95% in both cohorts: RR = 0.999 (95% CI 0.955–1.01), P = 0.309.
Deceased patients were older than survivors both in HD patients [73 (IQR 65–82) versus 69 (IQR 59–78) years; P &lt; 0.001] and in the general population [72 (IQR 63–82) versus 60 (IQR 48–69) years; P &lt; 0.001], however, the difference between medians was significantly greater in the general population: 13 (95% CI 12–14) versus 5 (95% CI 3–6) years.
Heart and lung diseases increased the risk of death. In the general population concomitant heart diseases worsened the prognosis to a greater extent compared with lung diseases: RR = 2.69 (95% CI 2.64–2.74), P &lt; 0.001 and RR = 1.3 (95% CI 1.26–1.35), P &lt; 0.001, respectively. In HD patients pre-existing lung diseases had a greater impact on the risk of death than heart diseases: RR = 2.02 (95% CI 1.71–2.41), P &lt; 0.001 and RR = 3.05 (95% CI 2.73–3.41), P &lt; 0.001, respectively.
In the multivariate model, significant predictors of death in HD patients were need for MV (OR = 9.81, 95% CI 8.48–17.8; P &lt; 0.001) and lung diseases (OR = 2.92, 95% CI 1.92–5.42; P &lt; 0.001], but not heart diseases, age and gender.

CONCLUSION
HD patients with COVID-19 have a significantly worse prognosis compared with the general population. The main risk factors for death are need for respiratory support and pre-existing lung diseases.