Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK

Selvaskandan, Haresh; Hull, Katherine L.; Adenwalla, Sherna; Ahmed, Safa; Cusu, Maria-Cristina; Graham-Brown, Matthew; Gray, Laura; Hall, Matt; Hamer, Rizwan; Kanbar, Ammar; Kanji, Hemali; Lambie, Mark; Lee, Han Sean; Mahdi, Khalid; Major, Rupert; Medcalf, James F.; Natarajan, Sushiladevi; Oseya, Boavojuvie; Stringer, Stephanie; Tabinor, Matthew; Burton, James

Abstract

Objectives To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis.

Setting A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK.

Participants All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres.

Exposur: The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19.

Main outcomes and measures Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of =75?mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation.

Results 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95%?CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings.

Conclusion The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.

Citation

Selvaskandan, H., Hull, K. L., Adenwalla, S., Ahmed, S., Cusu, M., Graham-Brown, M., …Burton, J. (2022). Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK. BMJ Open, 12(5), Article ARTN e054869. https://doi.org/10.1136/bmjopen-2021-054869

• Journal Article Type: Article
• Acceptance Date: Apr 28, 2022
• Publication Date: May 30, 2022
• Journal: BMJ Open
• Publisher: BMJ Publishing Group
• Volume: 12
• Issue: 5
• Article Number: ARTN e054869
• DOI: https://doi.org/10.1136/bmjopen-2021-054869
• Keywords: COVID-19; dialysis; epidemiology
• Publisher URL: https://bmjopen.bmj.com/content/12/5/e054869.info