Dialysis parameters associated with SARS-CoV-2 infection and prognosis in end-stage kidney disease
Creators: name: Bezerra, Rodrigo
name: Feitosa, Audes D.M.
name: Silvestre, Odilson M.
name: Fernandes-Silva, Miguel M.
name: Amazonas, Roberto B.
name: Teles, Flavio
name: Rodrigues, Cibele I. S.
name: Lima-Filho, Jose L.
name: Sposito, Andrei C.
name: Nadruz, Wilson
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Space Science
subject: Medicine
subject: Immunology
subject: FOS: Clinical medicine
subject: Biological Sciences not elsewhere classified
subject: Marine Biology
subject: Virology

description: The Covid-19 pandemic has affected patients with end-stage kidney disease (ESKD). Whether dialysis parameters have a prognostic value in ESKD patients with Covid-19 remains unclear. We retrospectively evaluated clinical characteristics, blood pressure (BP) and dialysis parameters in ESKD patients undergoing maintenance outpatient hemodialysis, with (Covid-ESKD) and without (No-Covid-ESKD) Covid-19, at four Brazilian hemodialysis facilities. The Covid-ESKD (<i>n</i> = 107; 54% females; 60.8 ± 17.7 years) and No-Covid-ESKD (<i>n</i> = 107; 62% females; 58.4 ± 14.6 years) groups were matched by calendar time. The average BP and dialysis parameters were calculated during the pre-infection, acute infection, and post-infection periods. The main outcomes were Covid-19 hospitalization and all-cause mortality. Covid-ESKD patients had greater intradialytic and postdialysis systolic BP and lower predialysis weight, postdialysis weight, ultrafiltration rate, and interdialytic weight gain during acute-illness compared to 1-week-before-illness, while these changes were not observed in No-Covid-ESKD patients. After 286 days of follow-up (range, 276–591), there were 18 Covid-19-related hospitalizations and 28 deaths among Covid-ESKD patients. Multivariable logistic regression analysis showed that increases in predialysis systolic BP from 1-week-before-illness to acute-illness (OR, 95%CI = 1.06, 1.02–1.10; <i>p</i> = .004) and Covid-19 vaccination (OR, 95%CI = 0.16, 0.04–0.69; <i>p</i> = .014) were associated with hospitalization in Covid-ESKD patients. Multivariable Cox-regression analysis showed that Covid-19-related hospitalization (HR, 95%CI = 5.17, 2.07–12.96; <i>p</i> &lt; .001) and age (HR, 95%CI = 1.05, 1.01–1.08; <i>p</i> = .008) were independent predictors of all-cause mortality in Covid-ESKD patients. Acute Covid-19 illness is associated with variations in dialysis parameters of volume status in patients with ESKD. Furthermore, increases in predialysis BP during acute Covid-19 illness are associated with an adverse prognosis in Covid-ESKD patients. Dialysis parameters were influenced by SARS-CoV-2 infection and may have prognostic value in patients with Covid-19.Increases in blood pressure during acute Covid-19 illness and the lack of vaccination for Covid-19 were predictors of hospitalization for Covid-19.Hospitalization for Covid-19 and age were independent risk factors for all-cause death. Dialysis parameters were influenced by SARS-CoV-2 infection and may have prognostic value in patients with Covid-19. Increases in blood pressure during acute Covid-19 illness and the lack of vaccination for Covid-19 were predictors of hospitalization for Covid-19. Hospitalization for Covid-19 and age were independent risk factors for all-cause death.