Mortality Rates and Predictors in Hospitalized COVID-19 Patients Receiving Hemodialysis for Different Conditions
COVıD-19 Mortality in HD Patients


DOI:
https://doi.org/10.5281/zenodo.15053951Keywords:
Hemodialysis, Chronic Kidney Disease, Mortality, Acute Kidney Injury, COVID-19Abstract
Background: To determine the mortality rates and predictors in patients hospitalized and treated for COVID-19 infection, who are also receiving hemodialysis (HD).
Method: This retrospective study included 104 patients who received HD and were hospitalized due to COVID-19 between March 2020 and 2021. Hospitalized patients who received HD were categorized into three groups: maintenance HD (MHD) patients, those receiving HD due to acute kidney injury (AKI) or chronic kidney disease (CKD), and those receiving HD due to AKI without CKD.
Results: Sixty-four (62%) of the patients were male. The mean age of the patients was 68±13 years. 37 were receiving MHD, 41 were receiving HD due to AKI on CKD, and 26 received HD due to AKI without CKD. 12(32%) of MHD patients and 29(71%) of patients receiving HD due to AKI on CKD died (p=0.002). Of the patients receiving HD due to AKI without CKD, 26(100%) died. Patients receiving HD due to AKI without CKD had the highest mortality rate compared to both MHD and AKI in CKD groups (p<0.001). Factors predicting mortality included lymphopenia, HD due to AKI on CKD, a more than two-fold increase in AST, the requirement of mechanical ventilation, and elevated d-dimer levels.
Conclusions: We showed high mortality in all patients receiving HD for different clinical conditions. These findings highlight the necessity of close monitoring and early intervention in COVID-19 patients who received HD.
References
Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney Int. 2020;97(5):824-8.
D'Marco L, Puchades MJ, Romero-Parra M, et al. Coronavirus disease 2019 in chronic kidney disease. Clin Kidney J. 2020;13(3):297-306.
Roper T, Kumar N, Lewis-Morris T, et al. Delivering Dialysis During the COVID-19 Outbreak: Strategies and Outcomes. Kidney Int Rep. 2020;5(7):1090-4.
Wang R, Liao C, He H, et al. COVID-19 in Hemodialysis Patients: A Report of 5 Cases. Am J Kidney Dis. 2020;76(1):141-3.
Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-18.
Yasar E, Ozger HS, Yeter HH, et al. Could urinary kidney injury molecule-1 be a good marker in subclinical acute kidney injury in mild to moderate COVID-19 infection? Int Urol Nephrol. 2022;54(3):627-36.
Su H, Yang M, Wan C, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020;98(1):219-27.
Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38.
Ozturk S, Turgutalp K, Arici M, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant. 2020;35(12):2083-95.
Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney international supplements. 2012;2(1):1-138.
Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010;55(4):622-7.
World Health Organization. Clinical management of COVID-19: interim guidance, 27 May 2020. World Health Organization;2020.
Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. Jama. 2020;323(16):1574-81.
Syed-Ahmed M, Narayanan M. Immune Dysfunction and Risk of Infection in Chronic Kidney Disease. Adv Chronic Kidney Dis. 2019;26(1):8-15.
Meyer TW, Hostetter TH. Uremia. N Engl J Med. 2007;357(13):1316-25.
Alberici F, Delbarba E, Manenti C, et al. Management of Patients on Dialysis and With Kidney Transplantation During the SARS-CoV-2 (COVID-19) Pandemic in Brescia, Italy. Kidney Int Rep. 2020;5(5):580-5.
Goicoechea M, Sánchez Cámara LA, Macías N, et al. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int. 2020;98(1):27-34.
Ng JH, Hirsch JS, Wanchoo R, et al. Outcomes of patients with end-stage kidney disease hospitalized with COVID-19. Kidney Int. 2020;98(6):1530-9.
Arikan H, Ozturk S, Tokgoz B, et al. Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology. PLoS One. 2021;16(8):e0256023.
Salgueira M, Almenara M, Gutierrez-Pizarraya A, et al. Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: renal replacement therapy and mortality. FRA-COVID SEN Registry Data. Nefrologia (Engl Ed). 2024;44(4):527-39.
Vardhan H, Saigal M, Shyama S, Krishna A. Clinical Features and Outcomes of Patients With COVID-19 Infection and Acute Kidney Injury Requiring Hemodialysis in an Intensive Care Unit: A Retrospective Study From a Tertiary Care Center in Eastern India. Cureus. 2024;16(12):e75363.
Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4.
Cai Q, Huang D, Yu H, et al. COVID-19: Abnormal liver function tests. J Hepatol. 2020;73(3):566-74.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
Rista E, Dervishi D, Cadri V, et al. Predictors of mortality in hemodialysis patients with COVID-19: A single-center experience. J Infect Dev Ctries. 2023;17(4):454-60.
Turgutalp K, Ozturk S, Arici M, et al. Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19. BMC Nephrol. 2021;22(1):29.
Yildirim C, Ozger HS, Yasar E, et al. Early predictors of acute kidney injury in COVID-19 patients. Nephrology (Carlton). 2021;26(6):513-21.
Shah M, Parikh M, Patel S, et al. COVID-19: Clinical Course and Outcome of hospitalized Hemodialysis Patients: Single-center Experience. J Assoc Physicians India. 2023;71(3):11-2.
asar E, Yildiz Y, Ozturk E, et al. Comparison of homologous and heterologous inactivated and mRNA vaccination programme against SARS-CoV-2 in dialysis patients. Nephrology (Carlton). 2024;29(7):405-14.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Mehmet Gurdal Savsar, Emre Yaşar, Ebru Gok Oguz, Mehmet Deniz Ayli

This work is licensed under a Creative Commons Attribution 4.0 International License.