Long-Term Outcomes of COVID-19 in Patients Receiving Maintenance Dialysis

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Key Points In maintenance dialysis patients, 90-day coronavirus disease 2019 (COVID-19) survivors did not have a higher long-term risk of death or adverse health outcomes. Prior COVID-19 infection was associated with a lower risk for subsequent COVID-19 infection. Background There is concern regarding the long-term impact of coronavirus disease 2019 (COVID-19) on the maintenance dialysis population. This study describes the long-term morbidity and mortality of COVID-19 among patients receiving maintenance dialysis in comparison with uninfected controls. Methods We conducted a population-based cohort study of patients receiving maintenance dialysis in Ontario, Canada, between March 14, 2020, and December 1, 2021 (pre-Omicron), with follow-up until March 31, 2023. We accounted for confounding using propensity scores to match each patient with COVID-19 to four uninfected controls. The primary outcome was all-cause mortality, whereas secondary outcomes included subsequent COVID-19 infection, COVID-19–associated death, a composite of cardiovascular (CV)-related death or hospitalization, all-cause hospitalization, and admission to long-term care or complex continuing care. Results Our matched cohort included 3340 maintenance dialysis patients: 668 with COVID-19 and 2672 controls. Over a median of 1.8 years of follow-up, the rate of long-term all-cause mortality for 90-day COVID-19 survivors was 11.9 deaths per 100 person-years which did not differ from 13.9 deaths per 100 person-years in those without COVID-19 infection (hazard ratio [HR] 0.86; 95% confidence interval [CI], 0.72 to 1.03). Similarly, no significant difference was observed on a composite outcome of CV death or hospitalization, all-cause hospitalization, long-term care, or complex continuing care placement. Prior COVID-19 infection was associated with a reduced risk of subsequent COVID-19 infection (HR, 0.75; 95% CI, 0.63 to 0.88). Subsequent COVID-19 infection was associated with a higher rate of death (HR, 1.68; 95% CI, 1.42 to 1.98). Conclusions Individuals receiving maintenance dialysis who survived their initial COVID-19 infection did not have an increased long-term risk of death, all-cause hospitalization, or CV disease compared with those without COVID-19. Subsequent COVID-19 infection during follow-up, however, was associated with increased mortality.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.