Abstract
Introduction: This retrospective cohort study compares in-centre haemodialysis (ICHD) patients’ outcomes between the 1st and 2nd waves of the COVID-19 pandemic in England, Wales, and Northern Ireland. Methods: All people aged ≥18 years receiving ICHD at 31 December 2019, who were still alive and not in receipt of a kidney transplant at 1 March and who had a positive polymerase chain reaction test for SARS-CoV-2 between 1 March 2020 and 31 January 2021, were included. The COVID-19 infections were split into two “waves”: wave 1 from March to August 2020 and wave 2 from September 2020 to January 2021. Cumulative incidence of COVID-19, multivariable Cox models for risk of positivity, median, and 95% credible interval of reproduction number in dialysis units were calculated separately for wave 1 and wave 2. Survival and hazard ratios for mortality were described with age- and sex-adjusted Kaplan-Meier plots and multivariable Cox proportional models. Results: 4,408 ICHD patients had COVID-19 during the study period. Unadjusted survival at 28 days was similar in both waves (wave 1 75.6% [95% confidence interval [CI]: 73.7–77.5], wave 2 76.3% [95% CI 74.3–78.2]), but death occurred more rapidly after detected infection in wave 1. Long vintage treatment and not being on the transplant waiting list were associated with higher mortality in both waves. Conclusions: Risk of death of patients on ICHD treatment with COVID-19 remained unchanged between the first and second outbreaks. This highlights that this vulnerable patient group needs to be prioritized for interventions to prevent severe COVID-19, including vaccination, and the implementation of measures to reduce the risk of transmission alone is not sufficient.
References
1.
Li
KK
, Woo
YM
, Stirrup
O
, Hughes
J
, Ho
A
, Da Silva Filipe
A
, Genetic epidemiology of SARS-CoV-2 transmission in renal dialysis units – a high risk community-hospital interface
. J Infect
. 2021 Apr
;83
(1
):96
–103
.2.
Wee
LE
, Conceicao
EP
, Sim
XYJ
, Aung
MK
, Tan
KY
, Wong
HM
, Minimizing intra-hospital transmission of COVID-19: the role of social distancing
. J Hosp Infect
. 2020 Jun
;105
(2
):113
–5
.3.
Savino
M
, Casula
A
, Santhakumaran
S
, Pitcher
D
, Wong
E
, Magadi
W
, Sociodemographic features and mortality of individuals on haemodialysis treatment who test positive for SARS-CoV-2: A UK Renal Registry data analysis
. PLoS One
. 2020 Oct
;15
(10
):e0241263
.4.
Mahon
J
, Oke
J
, Heneghan
C
. Declining death rate from COVID-19 in hospitals in England
. The Centre for Evidence-Based Medicine
; 2020
. Available from: https://www.cebm.net/covid-19/declining-death-rate-from-covid-19-in-hospitals-in-england/ (accessed July 6, 2021).5.
Office for National Statistics (ONS)
; Sutherland
E
, Headicar
J
, Delong
P
. Coronavirus (COVID-19) infection survey technical article: waves and lags of COVID-19 in England
. 2021
. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19infectionsurveytechnicalarticle/wavesandlagsofcovid19inenglandjune2021 (accessed July 8, 2021).6.
UK Government
. Coronavirus (COVID-19) in the UK
. 2021
. Available from: https://coronavirus.data.gov.uk/ (accessed June 8, 2021).7.
RECOVERY Collaborative Group
. Dexamethasone in hospitalized patients with Covid-19 – preliminary report
. N Engl J Med
. 2021 Feb
;384
:693
–704
.8.
REMAP-CAP Investigators
. Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19
. JAMA
. 2020 Oct
;324
(13
):1317
–29
.9.
ICNARC (Intensive Care National Audit and Research Centre)
. Reports
. 2021
. Available from: https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports (accessed March 3, 2021).10.
Karagiannidis
C
, Windisch
W
, McAuley
DF
, Welte
T
, Busse
R
. Major differences in ICU admissions during the first and second COVID-19 wave in Germany
. Lancet Respir Med
. 2021 May
;9
(5
):e47
–8
. .11.
UK Kidney Association
. COVID-19 UKKA resources
. 2020
. Available from: https://ukkidney.org/health-professionals/covid-19/ukka-resources (accessed May 20, 2021).12.
National Institute for Health and Care Excellence (NICE)
. COVID-19 rapid guideline: dialysis service delivery
. NICE Guideline [NG160]
; 2020
. Available from: https://www.nice.org.uk/guidance/ng160 (accessed February 5, 2021).13.
UK Government
. Coronavirus (COVID-19) in the UK
. Available from: https://coronavirus.data.gov.uk/details/download (accessed May 25, 2021).14.
Ministry of Housing, Communities & Local Government
. English indices of deprivation
. 2019
. Available from: https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019 (accessed January 27, 2021).15.
Office for National Statistics (ONS)
. Deaths registered weekly in England and Wales, provisional, 2021
. 2021
. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales (accessed May 25, 2021).16.
Cori
A
, Ferguson
NM
, Fraser
C
, Cauchemez
S
. A new framework and software to estimate time-varying reproduction numbers during epidemics
. Am J Epidemiol
. 2013 Nov 1
;178
(9
):1505
–12
. .17.
Du
Z
, Xu
X
, Wu
Y
, Wang
L
, Cowling
BJ
, Meyers
LA
. Serial interval of COVID-19 among publicly reported confirmed cases
. Emerg Infect Dis
. 2020 Jun
;26
(6
):1341
–3
. .18.
Nishiura
H
, Linton
NM
, Akhmetzhanov
AR
. Serial interval of novel coronavirus (COVID-19) infections
. Int J Infect Dis
. 2020 Apr
;93
:284
–6
. .19.
Office for National Statistics (ONS)
. Population estimates
. 2021
. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates (accessed May 25, 2021).20.
Institute for government
. Timeline of UK government coronavirus lockdowns
. 2021
. Available from: https://www.instituteforgovernment.org.uk/charts/uk-government-coronavirus-lockdowns (accessed June 28, 2021).21.
Haug
N
, Geyrhofer
L
, Londei
A
, Dervic
E
, Desvars-Larrive
A
, Loreto
V
, Ranking the effectiveness of worldwide COVID-19 government interventions
. Nat Hum Behav
. 2020 Dec
;4
:1303
–12
.22.
KQuIP COVID-19 Haemodialysis Patient Safety Working Group
. Recommendations for minimising the risk of transmission of COVID-19 in UK adult haemodialysis units
. 2021
. Available from: https://www.thinkkidneys.nhs.uk/kquip/wp-content/uploads/sites/5/2020/07/Recommendations-for-minimising-risk-of-transmission-of-COVID-19-on-UK-haemodialysis-units-FINAL-VERSION-WITH-FLOW-CHARTS-300620.pdf (accessed March 8, 2021).23.
KQuIP COVID-19 Haemodialysis Patient Safety Working Group
. Minimising the risk of transmission of COVID-19 in adult UK haemodialysis units – the KQuIP COVID-19 haemodialysis ensuring patient safety working group’s response to the pandemic
. 2021
. [publication in progress].24.
Hoxha
E
, Suling
A
, Turner
JE
, Haubitz
M
, Floege
J
, Huber
TB
, Coronavirus-disease-2019-Pandemie aus nephrologischer Perspektive [Coronavirus disease 2019 pandemic from a nephrological perspective]
. Internist
. 2021 Jul
;62
(7
):718
–24
.25.
Intensive Care National Audit and Research Centre
. ICNARC case mix programme database
. Available from: https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports (accessed December 1, 2021).26.
Reese
PP
, Shults
J
, Bloom
RD
, Mussell
A
, Harhay
MN
, Abt
P
, Functional status, time to transplantation, and survival benefit of kidney transplantation among wait-listed candidates
. Am J Kidney Dis
. 2015 Nov
;66
(5
):837
–45
.27.
Tennankore
KK
, Gunaratnam
L
, Suri
RS
, Yohanna
S
, Walsh
M
, Tangri
N
, Frailty and the kidney transplant wait list: protocol for a multicenter prospective study
. Can J Kidney Health Dis
. 2020 Sep
.28.
Chertow
GM
, Johansen
KL
, Lew
N
, Lazarus
JM
, Lowrie
EG
. Vintage, nutritional status, and survival in hemodialysis patients
. Kidney Int
. 2000 Mar
;57
(3
):1176
–81
. .29.
Sumida
K
, Yamagata
K
, Iseki
K
, Tsubakihara
Y
. Different impact of hemodialysis vintage on cause-specific mortality in long-term hemodialysis patients
. Nephrol Dial Transplant
. 2016 Feb
;31
(2
):298
–305
. .© 2022 S. Karger AG, Basel
2022
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
