1. Patients with end-stage kidney disease were at increased risk of COVID-19-related mortality, particularly among non-Hispanic Black patients.
Evidence Rating Level: 3 (Average)
End-stage kidney disease (ESKD) has been a significant contributor to COVID-19 mortality, with global fatality estimates falling between 20 to 30% of COVID-19 patients with ESKD. This retrospective cohort study identified patients with ESKD from Centers for Medicare and Medicaid Services data during epidemiologic weeks 3 through 27 of 2017 through 2020, and corresponding weeks of 2017 through 2019. These patients were then stratified by kidney replacement therapy, with primary outcomes being COVID-19 hospitalization, all-cause death, and other hospitalizations. In week 3 of 2020, a total of 568,533 (40.0% aged 45 to 64 years, 31.9% non-Hispanic Black) patients were receiving dialysis and another 237,746 (48.4% aged 45 to 64 years, 20.2% non-Hispanic Black) had a functioning transplant. Patients undergoing dialysis demonstrated a peak COVID-19 hospitalization rate between March 22 and April 25, 2020. Non-Hispanic Black and Hispanic race were associated with higher rates of COVID-19 hospitalization, compared to other racial identities. Adjusted relative risks of death in 2020, compared to 2017-2019, were 1.17 (95% CI 1.16 to 1.19) for those undergoing dialysis and 1.30 (95% CI 1.24 to 1.36) for those with a functioning transplant. Excess mortality was also higher among non-Hispanic Black, Hispanic, and Asian patients during the study period. Overall, this study of patients with ESKD suggests an increased risk of negative outcomes both in terms of all-cause mortality as well as COVID-19 mortality. Further, racial differences were readily apparent – aligning with other COVID-19 studies – and clearly demonstrate disparities within this medical population.
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