Shieu Monica M, Weiner Daniel E, Li Nien Chen, Manley Harold J, Harford Antonia, Hsu Caroline M, Miskulin Dana, Johnson Doug, Lacson Eduardo K
Quality Analytics, Dialysis Clinic Inc., Nashville, TN.
William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, MA.
Kidney Med. 2025 May 16;7(7):101026. doi: 10.1016/j.xkme.2025.101026. eCollection 2025 Jul.
RATIONALE & OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic disproportionately affected vulnerable individuals, including people with kidney disease. We elucidated longitudinal trends in hospitalization and mortality among individuals receiving maintenance dialysis before and during the pandemic and explored how universal vaccine availability affected COVID-19 outcomes by race/ethnicity.
A retrospective cohort study.
SETTINGS & PARTICIPANTS: Adult maintenance dialysis patients between 2018-2023 at a national not-for-profit US provider.
COVID-19 era (2020-2023), race/ethnicity.
COVID-19 vaccination status; hospitalization and death (COVID-related, all-cause).
Zero-inflated Poisson models and logistic regression models were used to calculate hospitalization and mortality rates, respectively, adjusted for age, sex, race/ethnicity, dialysis vintage, and number of comorbid conditions.
Among 41,257 patients receiving maintenance dialysis, all-cause hospitalization dropped abruptly in March/April 2020 and increased thereafter, albeit remaining below prepandemic rates. All-cause mortality exhibited typical seasonal variability during 2018-2019, subsequently increasing with onset of the COVID-19 pandemic in March 2020. Mortality peaked in January 2021 at 228 deaths per 1,000 person-years before declining to 151 deaths per 1,000 person-years in March 2021. Subsequently, mortality transiently increased during the Delta and Omicron variant periods, peaking at 188 and 189 deaths per 1,000 person-years, respectively. Thereafter, all-cause mortality remained below prepandemic levels. After widespread SARS-CoV-2 vaccine availability in 2021 with vaccine provision in dialysis facilities, the COVID-19 mortality rate among all race/ethnicity groups declined significantly (b = -5.3; < 0.001). There were no statistically significant differences by race/ethnicity in the vaccination status at each year's end.
Potential residual confounders and underreporting of COVID-19-related outcomes.
All-cause mortality increased sharply in 2020 and early 2021, reflecting COVID-19-related deaths, whereas non-COVID-19 mortality declined during the early phase of the pandemic and subsequently remained below prepandemic levels. After introduction of SARS-CoV-2 vaccines, all-cause mortality declined to below prepandemic levels, likely reflecting the impact of widespread vaccination in the dialysis population.
2019年冠状病毒病（COVID-19）大流行对包括肾病患者在内的弱势群体造成了不成比例的影响。我们阐明了大流行之前和期间接受维持性透析的个体的住院和死亡率的纵向趋势，并探讨了普遍可获得疫苗如何按种族/民族影响COVID-19的结局。
一项回顾性队列研究。
美国一家全国性非营利性机构在2018 - 2023年期间的成年维持性透析患者。
COVID-19时期（2020 - 2023年），种族/民族。
COVID-19疫苗接种状况；住院和死亡（与COVID相关的、全因性的）。
使用零膨胀泊松模型和逻辑回归模型分别计算住院率和死亡率，并对年龄、性别、种族/民族、透析时间和合并症数量进行了调整。
在41,257例接受维持性透析的患者中，2020年3月/4月全因住院率急剧下降，此后有所上升，尽管仍低于大流行前的水平。2018 - 2019年期间全因死亡率呈现典型的季节性变化，随后随着2020年3月COVID-19大流行的开始而上升。死亡率在2021年1月达到峰值，为每1000人年228例死亡，随后在2021年3月降至每1000人年151例死亡。随后，在德尔塔和奥密克戎变异株流行期间死亡率短暂上升，分别达到每1000人年188例和189例死亡的峰值。此后，全因死亡率一直低于大流行前的水平。2021年SARS-CoV-2疫苗广泛可用且在透析机构中提供疫苗后，所有种族/民族群体的COVID-19死亡率显著下降（b = -5.3；P < 0.001）。每年年底的疫苗接种状况在种族/民族方面没有统计学上的显著差异。
潜在的残余混杂因素以及COVID-19相关结局的报告不足。
2020年和2021年初全因死亡率急剧上升，反映了与COVID-19相关的死亡，而在大流行早期非COVID-19死亡率下降，随后一直低于大流行前的水平。引入SARS-CoV-2疫苗后，全因死亡率降至大流行前水平以下，这可能反映了透析人群中广泛接种疫苗的影响。
