Maintenance dialysis tied to increased COVID-19 risk

Among patients with chronic kidney disease (CKD), those receiving maintenance dialysis are more susceptible to COVID-19 infection than those who do not require kidney replacement therapy or those who are kidney or pancreas-kidney transplant recipients, as shown in a study.

Furthermore, the presence of COVID-19 may put CKD patients at higher risk of mortality.

Researchers conducted a systematic review and meta-analysis of cohort and case-control studies. They accessed multiple online databases and identified 348 studies, which included a total of 1,139,979 total participants with CKD, among whom 382,407 contracted COVID-19.

Pooled data showed that the incidence of COVID-19 among CKD patients undergoing dialysis was 105 per 10,000 person-weeks (95 percent confidence interval [CI], 91–120; 95 percent prediction interval [PrI], 25–235; 59 studies; 468,233 participants). This was markedly higher than the incidence rates recorded among CKD patients not requiring kidney replacement therapy (16 per 10,000 person-weeks, 95 percent CI, 4–33; 95 percent PrI, 0–92; five studies; 70,683 participants) and kidney or pancreas-kidney transplant recipients (23 per 10,000 person-weeks, 95 percent CI, 18–30; 95 percent PrI, 2–67; 29 studies; 120,281 participants).

Meanwhile, people with CKD and COVID-19 had a higher incidence of death (32 per 1,000 person-weeks, 95 percent CI, 30–35; 95 percent PrI, 4–81; 229 studies; 70,922 participants) than those with CKD without COVID-19 (incidence rate ratio, 10.26, 95 percent CI, 6.78–15.53; 95 percent PrI, 2.62–40.15; four studies; 18,347 participants).

The meta-analysis was limited by its low-certainty evidence. Also, the number of studies that documented outcomes in CKD patients without COVID-19 was not enough to calculate the excess risk attributable to COVID-19. Finally, most included studies did not adjust for potential confounders.