Adverse outcomes post-COVID-19 hospitalization among ESRD patients: A retrospective cohort study in 5 California university medical centers

1. Among patients hospitalized with COVID-19, end-stage renal disease was not associated with risk for hospital, non-hospital, or overall death within 180 days post-discharge, but was associated with increased risk of 30-day hospital readmission.

Evidence Rating Level: 2 (Good)

Patients receiving hemodialysis for end-stage renal disease (ESRD) are known to have a high 30-day readmission rate, a pattern also seen for COVID-19-related hospitalizations. Individuals with ESRD hospitalized for COVID-19 may therefore have a higher risk for adverse events after discharge. This study examined whether ESRD is associated with higher risk for death within 180 days or for 30-day hospital readmission among patients hospitalized for COVID-19. This retrospective cohort study used data from the University of California COVID Research Database, covering five California medical centers, and included adults (>18 years) with and without ESRD who were hospitalized for COVID-19 between January 6, 2020, and August 3, 2023, and discharged alive by August 4, 2023. Among the 11,406 patients included in the study, 713 (6.3%) had ESRD. Compared to patients without ESRD, those with ESRD had a higher risk of hospital (hazard ratio [HR] 2.15, 95% CI 1.27–3.63) and overall death (HR 1.49, 95% CI 1.05–2.11) within 180 days post-discharge. However, these results were no longer significant after adjusting for covariates. No association was found between ESRD and risk of non-hospital death within 180 days post-discharge. Patients with ESRD had a higher risk of 30-day hospital readmission, even after adjusting for covariates (adjusted HR 1.36, 95% CI 1.14–1.63). Overall, this study found that ESRD status among patients hospitalized with COVID-19 was not associated with risk for hospital, non-hospital, or overall death within 180 days post-discharge, but was associated with increased risk of 30-day hospital readmission. These findings suggest the need for closer post-discharge follow-up and care coordination in this population.

Click to read this study in PLOS One

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