Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK
Selvaskandan, Haresh Hull, Katherine L Adenwalla, Sherna Ahmed, Safa Cusu, Maria-Cristina Graham-Brown, Matthew Gray, Laura Hall, Matt Hamer, Rizwan Kanbar, Ammar
Selvaskandan, Haresh
Hull, Katherine L
Adenwalla, Sherna
Ahmed, Safa
Cusu, Maria-Cristina
Graham-Brown, Matthew
Gray, Laura
Hall, Matt
Hamer, Rizwan
Kanbar, Ammar
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Affiliation
University Hospitals of Leicester NHS Trust; University of Leicester; University Hospitals Coventry and Warwickshire NHS Trust; Northampton General Hospital NHS Trust; Nottingham University Hospitals NHS Trust; Royal Stoke University Hospital; Keele University; Lincoln County Hospital; University Hospitals Birmingham NHS Foundation Trust
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Publication date
2022-05-30
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Abstract
Objectives: To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis.
Setting: A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK.
Participants: All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres.
Exposure: The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19.
Main outcomes and measures: Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation.
Results: 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings.
Conclusion: The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.
Citation
Selvaskandan H, Hull KL, Adenwalla S, Ahmed S, Cusu MC, Graham-Brown M, Gray L, Hall M, Hamer R, Kanbar A, Kanji H, Lambie M, Lee HS, Mahdi K, Major R, Medcalf JF, Natarajan S, Oseya B, Stringer S, Tabinor M, Burton J. Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK. BMJ Open. 2022 May 30;12(5):e054869. doi: 10.1136/bmjopen-2021-054869.
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Article