Incidence, clinical presentation, and mortality of SARS-CoV-2 infection in patients on chronic dialysis during the first stage of the pandemic in Uruguay

Abstract

Objective: In March 2020, a health emergency was declared due to COVID-19 in Uruguay. Patients undergoing chronic dialysis (CD) were particularly affected by the disease. The objective is to describe the incidence, clinical presentation, and mortality of patients in CD with COVID-19 at the beginning of the pandemic. Material and methods: All patients in CD in Uruguay were included in the period from 03-01-2020 to 03-31-2021. Clinical, analytical, and morbidity/mortality data were collected for those who had COVID-19 and compared with the general population for the same period. Results: 232 patients in CD (97.8% hemodialysis) had COVID-19 (infection rate: 8045.58/100,000), doubling the infection rate of the general population (4653.51/100,000), with a similar profile of new cases in both groups. Most presented symptoms (73.7%), 36.6% requiring hospitalization (15.5% in critical care) and 10.3% requiring invasive ventilation. Mortality was 22.4%, significantly higher than the general population for all age groups. Patients in CD who died from COVID-19 were older (69.5 vs. 59.5 years) and had more cardiovascular morbidity (80.8 vs. 61.7%) than those who survived. Presence of cardiovascular disease (HR: 2.996; p = 0.082), need for hospitalization (HR: 2.563; p = 0.097), and requirement for invasive ventilation (HR: 2.149; p = 0.037) increased mortality. Conclusions: COVID-19 had a high infection rate, high morbidity, and high mortality in patients in CD in the early stage of the pandemic.

Keywords

• Coronavirus disease 19. Chronic dialysis. Hemodialysis. Peritoneal dialysis.