Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort
Guillaume Lano, Antoine Braconnier, Stanislas Bataille, Guilhem Cavaille, Julie Moussi-Frances, Bertrand Gondouin, Pascal Bindi, Magued Nakhla, Janette Mansour, Pascale Halin, Bénédicte Levy, Eric Canivet, Khaled Gaha, Isabelle Kazes, Natacha Noel, Alain Wynckel, Alexandre Debrumetz, Noemie Jourde-Chiche, Valerie Moal, Romain Vial, Violaine Scarfoglière, Mickael Bobot, Marion Gully, Tristan Legris, Marion Pelletier, Marion Sallee, Stephane Burtey, Philippe Brunet, Thomas Robert, Philippe Rieu
Clinical Kidney Journal, doi:10.1093/ckj/sfaa199
Background. Coronavirus disease 2019 (COVID-19) is an emerging infectious disease, related to severe acute respiratory syndrome coronavirus 2 infection. Few data are available in patients with end-stage renal disease (ESRD). Methods. We conducted an observational cohort study of COVID-19 patients at 11 dialysis centres in two distinct districts of France to examine the epidemiological and clinical characteristics of COVID-19 in this population, and to determine risk factors of disease severity (defined as a composite outcome including intensive care unit admission or death) and mortality. Results. Among the 2336 patients enrolled, 5.5% had confirmed COVID-19 diagnosis. Of the 122 patients with a follow-up superior to 28 days, 37% reached the composite outcome and 28% died. Multivariate analysis showed that oxygen therapy on diagnosis and a decrease in lymphocyte count were independent risk factors associated with disease severity and with mortality. Chronic use of angiotensin II receptor blockers (ARBs) (18% of patients) was associated with a protective effect on mortality. Treatment with azithromycin and hydroxychloroquine (AZT/HCQ) (46% of patients) were not associated with the composite outcome and with death in univariate and multivariate analyses. Conclusions. COVID-19 is a severe disease with poor prognosis in patients with ESRD. Usual treatment with ARBs seems to be protective of critical evolution and mortality. There is no evidence of clinical benefit with the combination of AZT/HCQ.
SUPPLEMENTARY DATA Supplementary data are available at ckj online.
AUTHORS' CONTRIBUTIONS G.L., A.B., T.R. and P.R. conceived and designed the study, and drafted the manuscript. S.Bataille, G.C., J.M.-F., B.G., P.Bindi, M.N., J.M., P.H., B.L., E.C., K.G., I.K., N.N., A.W., A.D., N.J.-C., V.M., R.V., V.S., M.B., M.G., T.L., M.P., M.S., S.Burtey and P.Brunet were involved in data collection analysis and provided guidance. All authors critically revised the manuscript for important intellectual content and approved the final version for publication.
CONFLICT OF INTEREST STATEMENT All the authors declare that they have no conflict of interest.
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"abstract": "<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Coronavirus disease 2019 (COVID-19) is an emerging infectious disease, related to severe acute respiratory syndrome coronavirus 2 infection. Few data are available in patients with end-stage renal disease (ESRD).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted an observational cohort study of COVID-19 patients at 11 dialysis centres in two distinct districts of France to examine the epidemiological and clinical characteristics of COVID-19 in this population, and to determine risk factors of disease severity (defined as a composite outcome including intensive care unit admission or death) and mortality.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among the 2336 patients enrolled, 5.5% had confirmed COVID-19 diagnosis. Of the 122 patients with a follow-up superior to 28 days, 37% reached the composite outcome and 28% died. Multivariate analysis showed that oxygen therapy on diagnosis and a decrease in lymphocyte count were independent risk factors associated with disease severity and with mortality. Chronic use of angiotensin II receptor blockers (ARBs) (18% of patients) was associated with a protective effect on mortality. Treatment with azithromycin and hydroxychloroquine (AZT/HCQ) (46% of patients) were not associated with the composite outcome and with death in univariate and multivariate analyses.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>COVID-19 is a severe disease with poor prognosis in patients with ESRD. Usual treatment with ARBs seems to be protective of critical evolution and mortality. There is no evidence of clinical benefit with the combination of AZT/HCQ.</jats:p></jats:sec>",
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