ICES, Toronto, Ontario, Canada.
Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada.
Kidney360. 2024 Aug 1;5(8):1116-1125. doi: 10.34067/KID.0000000000000490. Epub 2024 Aug 16.
The rates of long-term mortality, reinfection, cardiovascular outcomes, and hospitalization were high among coronavirus disease 2019 (COVID-19) survivors on maintenance dialysis. Several risk factors, including intensive care unit admission related to COVID-19 and reinfection, were found to have a prolonged effect on survival. This study shows that the burden of COVID-19 remains high after the period of acute infection in the population receiving maintenance dialysis.
Many questions remain about the population receiving maintenance dialysis who survived coronavirus disease 2019 (COVID-19). Previous literature has focused on outcomes associated with the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it may underestimate the effect of disease. This study describes the long-term morbidity and mortality among patients receiving maintenance dialysis in Ontario, Canada, who survived SARS-CoV-2 infection and the risk factors associated with long-term mortality.
We conducted a population-based cohort study of patients receiving maintenance dialysis in Ontario, Canada, who tested positive for SARS-CoV-2 and survived 30 days between March 14, 2020, and December 1, 2021 (pre-Omicron), with follow-up until September 30, 2022. Our primary outcome was all-cause mortality while our secondary outcomes included reinfection, composite of cardiovascular (CV)–related death or hospitalization, all-cause hospitalization, and admission to long-term care or complex continuing care. We also examined risk factors associated with long-term mortality using multivariable Cox proportional hazards regression.
We included 798 COVID-19 survivors receiving maintenance dialysis. After the first 30 days of infection, death occurred at a rate of 15.0 per 100 person-years (95% confidence interval [CI], 12.9 to 17.5) over a median follow-up of 1.4 years (interquartile range, 1.1–1.7) with a nadir of death at approximately 0.5 years. Reinfection, composite CV death or hospitalization, and all-cause hospitalization occurred at a rate (95% CI) of 15.9 (13.6 to 18.5), 17.4 (14.9 to 20.4), and 73.1 (66.6 to 80.2) per 100 person-years, respectively. In addition to traditional predictors of mortality, intensive care unit admission for COVID-19 had a prolonged effect on survival (adjusted hazard ratio, 2.6; 95% CI, 1.6 to 4.3). Reinfection with SARS-CoV-2 among 30-day survivors increased all-cause mortality (adjusted hazard ratio, 2.2; 95% CI, 1.4 to 3.3).
The burden of COVID-19 persists beyond the period of acute infection in the population receiving maintenance dialysis in Ontario with high rates of death, reinfection, all-cause hospitalization, and CV disease among COVID-19 survivors.
在维持性透析的 COVID-19 幸存者中，长期死亡率、再感染、心血管结局和住院率均较高。发现包括与 COVID-19 相关的重症监护室入院和再感染在内的几个危险因素对生存有长期影响。本研究表明，在接受维持性透析的人群中，急性感染期过后，COVID-19 的负担仍然很高。
许多问题仍然存在于接受维持性透析并幸存 COVID-19 的人群中。以前的文献主要集中在与初始严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染相关的结局上，但这可能低估了疾病的影响。本研究描述了加拿大安大略省接受维持性透析的 SARS-CoV-2 感染幸存者的长期发病率和死亡率，以及与长期死亡率相关的危险因素。
我们对 2020 年 3 月 14 日至 2021 年 12 月 1 日（Omicron 之前）期间在加拿大安大略省检测出 SARS-CoV-2 阳性并存活 30 天的接受维持性透析的患者进行了一项基于人群的队列研究，随访至 2022 年 9 月 30 日。我们的主要结局是全因死亡率，次要结局包括再感染、心血管（CV）相关死亡或住院的复合结局、全因住院、以及进入长期护理或复杂持续护理。我们还使用多变量 Cox 比例风险回归来检查与长期死亡率相关的危险因素。
我们纳入了 798 名 COVID-19 幸存者接受维持性透析。在感染后的头 30 天，中位随访 1.4 年（四分位距，1.1-1.7）后，死亡率为每 100 人年 15.0（95%置信区间，12.9-17.5），死亡率的最低点约为 0.5 年。再感染、CV 死亡或住院的复合结局以及全因住院的发生率（95%CI）分别为 15.9（13.6-18.5）、17.4（14.9-20.4）和 73.1（66.6-80.2）/100 人年。除了死亡率的传统预测因素外，COVID-19 的重症监护室入院对生存也有长期影响（调整后的危险比，2.6；95%CI，1.6-4.3）。30 天幸存者的 SARS-CoV-2 再感染增加了全因死亡率（调整后的危险比，2.2；95%CI，1.4-3.3）。
在安大略省接受维持性透析的人群中，COVID-19 的负担在急性感染期过后仍然存在，COVID-19 幸存者的死亡率、再感染、全因住院率和心血管疾病发生率均较高。
