Dataset Information

Risk prediction of COVID-19 incidence and mortality in a large multi-national hemodialysis cohort: implications for management of the pandemic in outpatient hemodialysis settings.

ABSTRACT:

Background

Experiences from the first wave of the 2019 coronavirus disease (COVID-19) pandemic can aid in the development of future preventive strategies. To date, risk prediction models for COVID-19-related incidence and outcomes in hemodialysis (HD) patients are missing.

Methods

We developed risk prediction models for COVID-19 incidence and mortality among HD patients. We studied 38 256 HD patients from a multi-national dialysis cohort between 3 March and 3 July 2020. Risk prediction models were developed and validated, based on predictors readily available in outpatient HD units. We compared mortality among patients with and without COVID-19, matched for age, sex and diabetes.

Results

During the observational period, 1259 patients (3.3%) acquired COVID-19. Of these, 62% were hospitalized or died. Mortality was 22% among COVID-19 patients with odds ratios 219.8 [95% confidence interval (CI) 80.6-359] to 342.7 (95% CI 60.6-13 595.1), compared to matched patients without COVID-19. Since the first wave of the pandemic affected most European countries during the study, the risk prediction model for incidence of COVID-19 was developed and validated in European patients only [N = 22 826 area under the ROC curve(AUC)_Dev 0.64, AUC_Val 0.69]. The model for prediction of mortality was developed in all COVID-19 patients (AUC_Dev 0.71, AUC_Val 0.78). Angiotensin receptor blockers were independently associated with a lower incidence of COVID-19 in European patients.

Conclusions

We identified modifiable risk factors for COVID-19 incidence and outcome in HD patients. Our risk prediction tools can be readily applied in clinical practice. This can aid in the development of preventive strategies for future waves of COVID-19.

SUBMITTER: Haarhaus M

PROVIDER: S-EPMC7929029 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThis study aimed to assess the situational capacity for nutrition care delivery in the outpatient hemodialysis (HD) setting in Malaysia by evaluating dietitian accessibility, nutrition practices and patients' outcomes.MethodsA 17-item questionnaire was developed to assess nutrition practices and administered to dialysis managers of 150 HD centers, identified through the National Renal Registry. Nutritional outcomes of 4362 patients enabled crosscutting comparisons as per dietitian accessibility and center sector.ResultsDedicated dietitian (18%) and visiting/shared dietitian (14.7%) service availability was limited, with greatest accessibility at government centers (82.4%)?>?non-governmental organization (NGO) centers (26.7%)?>?private centers (15.1%). Nutritional monitoring varied across HD centers as per albumin (100%)?>?normalized protein catabolic rate (32.7%)?>?body mass index (BMI, 30.7%)?>?dietary intake (6.0%). Both sector and dietitian accessibility was not associated with achieving albumin ?40?g/L. However, NGO centers were 36% more likely (p?=?0.030) to achieve pre-dialysis serum creatinine ?884??mol/L compared to government centers, whilst centers with dedicated dietitian service were 29% less likely (p?=?0.017) to achieve pre-dialysis serum creatinine ?884??mol/L. In terms of BMI, private centers were 32% more likely (p?=?0.022) to achieve BMI???25.0?kg/m2 compared to government centers. Private centers were 62% less likely (p?<? 0.001) while NGO centers were 56% less likely (p?<? 0.001) to achieve serum phosphorus control compared to government centers. Patients from centers with a shared/visiting dietitian had 35% lower probability (p?<? 0.001) to achieve serum phosphorus levels below 1.78?mmol/L compared to centers without access to a dietitian.ConclusionsThere were clear discrepancies in nutritional care in Malaysian HD centers. Changes in stakeholder policy are required to ensure that dietitian service is available in Malaysian HD centers.

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