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

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Abstract

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.

A newrisk prediction model has been invented for COVID-19 incidence and mortality among hemodialysis  patients. There were studied 38 256 hemodialysis  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 hemodialysis  units. We compared mortality among patients with and without COVID-19, matched for age, sex and diabetes.

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, 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  The model for prediction of mortality was developed in all COVID-19 patients. Angiotensin receptor blockers were independently associated with a lower incidence of COVID-19 in European patients.

Conclusions: There were identified modifiable risk factors for COVID-19 incidence and outcome in hemodialysis patients. Such 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. Angiotensin receptor blockers can be one of the reliable markers of anomalies in COVID-19 disease development in hemodialysis patients.

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