Ding Xuemei, Wang Xi, Gremel Garrett W, He Kevin, Kang Jian, Messana Joseph M, Dahlerus Claudia, Wu Wenbo, Hirth Richard A, Kalbfleisch John D
Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
Kidney Med. 2022 Nov;4(11):100537. doi: 10.1016/j.xkme.2022.100537. Epub 2022 Aug 24.
RATIONALE & OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on hospitalizations in general and on dialysis patients in particular. This study modeled the impact of COVID-19 on hospitalizations of dialysis patients in 2020.
Retrospective cohort study.
SETTING & PARTICIPANTS: Medicare patients on dialysis in calendar year 2020.
COVID-19 status was divided into 4 stages: COVID1 (first 10 days after initial diagnosis), COVID2 (extends until the Post-COVID stage), Post-COVID (after 21 days with no COVID-19 diagnosis), and Late-COVID (begins after a hospitalization with a COVID-19 diagnosis); demographic and clinical characteristics; and dialysis facilities.
The sequence of hospitalization events.
A proportional rate model with a nonparametric baseline rate function of calendar time on the study population.
A total of 509,609 patients were included in the study, 63,521 were observed to have a SARS-CoV-2 infection, 34,375 became Post-COVID, and 1,900 became Late-COVID. Compared with No-COVID, all 4 stages had significantly greater adjusted risks of hospitalizations with relative rates of 18.50 (95% CI, 18.19-18.81) for COVID1, 2.03 (95% CI, 1.99-2.08) for COVID2, 1.37 (95% CI, 1.35-1.40) for Post-COVID, and 2.00 (95% CI, 1.89-2.11) for Late-COVID.
For Medicare Advantage patients, we only had inpatient claim information. The analysis was based on data from the year 2020, and the effects may have changed due to vaccinations, new treatments, and new variants. The COVID-19 effects may be somewhat overestimated due to missing information on patients with few or no symptoms and possible delay in COVID-19 diagnosis.
We discovered a marked time dependence in the effect of COVID-19 on hospitalization of dialysis patients, beginning with an extremely high risk for a relatively short period, with more moderate but continuing elevated risks later, and never returning to the No-COVID level.
2019年冠状病毒病（COVID-19）大流行对总体住院情况，尤其是对透析患者产生了深远影响。本研究模拟了COVID-19对2020年透析患者住院情况的影响。
回顾性队列研究。
2020日历年接受透析的医疗保险患者。
COVID-19状态分为4个阶段：COVID1（初次诊断后的前10天）、COVID2（持续至COVID后阶段）、COVID后（在21天内未诊断出COVID-19）和晚期COVID（在确诊COVID-19住院后开始）；人口统计学和临床特征；以及透析设施。
住院事件序列。
对研究人群采用具有日历时间非参数基线率函数的比例率模型。
本研究共纳入509,609名患者，其中63,521人被观察到感染了SARS-CoV-2，34,375人进入COVID后阶段，1,900人进入晚期COVID阶段。与未感染COVID相比，所有4个阶段的住院调整风险均显著更高，COVID1阶段的相对率为18.50（95%CI，18.19 - 18.81），COVID2阶段为2.03（95%CI，1.99 - 2.08），COVID后阶段为1.37（95%CI，1.35 - 1.40），晚期COVID阶段为2.00（95%CI，1.89 - 2.11）。
对于医疗保险优势计划患者，我们仅有住院索赔信息。分析基于2020年的数据，由于疫苗接种、新治疗方法和新变种，影响可能已发生变化。由于无症状或症状轻微患者的信息缺失以及COVID-19诊断可能存在延迟，COVID-19的影响可能被高估。
我们发现COVID-19对透析患者住院的影响存在明显的时间依赖性，开始时在相对较短时间内风险极高，随后风险较为适中但持续升高，且从未恢复到未感染COVID的水平。
