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Increased 1-year mortality in haemodialysis patients with COVID-19: a prospective, observational study
BACKGROUND: Dialysis confers the highest risk of coronavirus disease 2019 (COVID-19) death among comorbidities predisposing to severe COVID-19. However, reports of COVID-19-associated mortality frequently refer to mortality during the initial hospitalization or first month after diagnosis. METHODS:...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8755355/ https://www.ncbi.nlm.nih.gov/pubmed/35198156 http://dx.doi.org/10.1093/ckj/sfab248 |
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author | Carriazo, Sol Mas-Fontao, Sebastian Seghers, Clara Cano, Jaime Goma, Elena Avello, Alejandro Ortiz, Alberto Gonzalez-Parra, Emilio |
author_facet | Carriazo, Sol Mas-Fontao, Sebastian Seghers, Clara Cano, Jaime Goma, Elena Avello, Alejandro Ortiz, Alberto Gonzalez-Parra, Emilio |
author_sort | Carriazo, Sol |
collection | PubMed |
description | BACKGROUND: Dialysis confers the highest risk of coronavirus disease 2019 (COVID-19) death among comorbidities predisposing to severe COVID-19. However, reports of COVID-19-associated mortality frequently refer to mortality during the initial hospitalization or first month after diagnosis. METHODS: In a prospective, observational study, we analysed the long-term (1-year follow-up) serological and clinical outcomes of 56 haemodialysis (HD) patients who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first pandemic wave. COVID-19 was diagnosed by a positive polymerase chain reaction (PCR) test (n = 37) or by the development of anti-SARS-CoV-2 antibodies (n = 19). RESULTS: After >1 year of follow-up, 35.7% of HD patients infected by SARS-CoV-2 during the first pandemic wave had died, 6 (11%) during the initial admission and 14 (25%) in the following months, mainly within the first 3 months after diagnosis. Overall, 30% of patients died from vascular causes and 40% from respiratory causes. In adjusted analysis, a positive SARS-CoV-2 PCR test for diagnosis {hazard ratio [HR] 5.18 [interquartile range (IQR) 1.30–20.65], P = 0.020}, higher baseline C-reactive protein levels [HR 1.10 (IQR 1.03–1.16), P = 0.002] and lower haemoglobin levels [HR 0.62 (IQR 0.45–0.86), P = 0.005] were associated with higher 1-year mortality. Mortality in the 144 patients who did not have COVID-19 was 21 (14.6%) over 12 months [HR of death for COVID-19 patients 3.00 (IQR 1.62–5.53), log-rank P = 0.00023]. Over the first year, the percentage of patients having anti-SARS-CoV-2 immunoglobulin G (IgG) decreased from 36/49 (73.4%) initially to 27/44 (61.3%) at 6 months and 14/36 (38.8%) at 12 months. CONCLUSIONS: The high mortality of HD patients with COVID-19 is not limited to the initial hospitalization. Defining COVID-19 deaths as those occurring within 3 months of a COVID-19 diagnosis may better represent the burden of COVID-19. In HD patients, the anti-SARS-CoV-2 IgG response was suboptimal and short-lived. |
format | Online Article Text |
id | pubmed-8755355 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-87553552022-01-13 Increased 1-year mortality in haemodialysis patients with COVID-19: a prospective, observational study Carriazo, Sol Mas-Fontao, Sebastian Seghers, Clara Cano, Jaime Goma, Elena Avello, Alejandro Ortiz, Alberto Gonzalez-Parra, Emilio Clin Kidney J Original Article BACKGROUND: Dialysis confers the highest risk of coronavirus disease 2019 (COVID-19) death among comorbidities predisposing to severe COVID-19. However, reports of COVID-19-associated mortality frequently refer to mortality during the initial hospitalization or first month after diagnosis. METHODS: In a prospective, observational study, we analysed the long-term (1-year follow-up) serological and clinical outcomes of 56 haemodialysis (HD) patients who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first pandemic wave. COVID-19 was diagnosed by a positive polymerase chain reaction (PCR) test (n = 37) or by the development of anti-SARS-CoV-2 antibodies (n = 19). RESULTS: After >1 year of follow-up, 35.7% of HD patients infected by SARS-CoV-2 during the first pandemic wave had died, 6 (11%) during the initial admission and 14 (25%) in the following months, mainly within the first 3 months after diagnosis. Overall, 30% of patients died from vascular causes and 40% from respiratory causes. In adjusted analysis, a positive SARS-CoV-2 PCR test for diagnosis {hazard ratio [HR] 5.18 [interquartile range (IQR) 1.30–20.65], P = 0.020}, higher baseline C-reactive protein levels [HR 1.10 (IQR 1.03–1.16), P = 0.002] and lower haemoglobin levels [HR 0.62 (IQR 0.45–0.86), P = 0.005] were associated with higher 1-year mortality. Mortality in the 144 patients who did not have COVID-19 was 21 (14.6%) over 12 months [HR of death for COVID-19 patients 3.00 (IQR 1.62–5.53), log-rank P = 0.00023]. Over the first year, the percentage of patients having anti-SARS-CoV-2 immunoglobulin G (IgG) decreased from 36/49 (73.4%) initially to 27/44 (61.3%) at 6 months and 14/36 (38.8%) at 12 months. CONCLUSIONS: The high mortality of HD patients with COVID-19 is not limited to the initial hospitalization. Defining COVID-19 deaths as those occurring within 3 months of a COVID-19 diagnosis may better represent the burden of COVID-19. In HD patients, the anti-SARS-CoV-2 IgG response was suboptimal and short-lived. Oxford University Press 2021-12-20 /pmc/articles/PMC8755355/ /pubmed/35198156 http://dx.doi.org/10.1093/ckj/sfab248 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Carriazo, Sol Mas-Fontao, Sebastian Seghers, Clara Cano, Jaime Goma, Elena Avello, Alejandro Ortiz, Alberto Gonzalez-Parra, Emilio Increased 1-year mortality in haemodialysis patients with COVID-19: a prospective, observational study |
title | Increased 1-year mortality in haemodialysis patients with COVID-19: a
prospective, observational study |
title_full | Increased 1-year mortality in haemodialysis patients with COVID-19: a
prospective, observational study |
title_fullStr | Increased 1-year mortality in haemodialysis patients with COVID-19: a
prospective, observational study |
title_full_unstemmed | Increased 1-year mortality in haemodialysis patients with COVID-19: a
prospective, observational study |
title_short | Increased 1-year mortality in haemodialysis patients with COVID-19: a
prospective, observational study |
title_sort | increased 1-year mortality in haemodialysis patients with covid-19: a
prospective, observational study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8755355/ https://www.ncbi.nlm.nih.gov/pubmed/35198156 http://dx.doi.org/10.1093/ckj/sfab248 |
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