Chronic Hemodialysis Patients Hospitalized with COVID-19 - Short-term Outcomes in Bronx, New York

Background: End-stage kidney disease (ESKD) patients on chronic hemodialysis have a high burden of comorbidities that may place them at increased risk for adverse outcomes when hospitalized with COVID-19. However, data in this unique patient population is limited. The aim of our study is to describe the clinical characteristics and short term outcomes in chronic hemodialysis patients requiring hospitalization for COVID-19. Methods: We performed a retrospective study of 114 chronic hemodialysis patients hospitalized at two major hospitals in the Bronx with COVID-19 from March 9-April 8, 2020 during the surge of coronavirus infections in New York City. Patients were followed during their hospitalization through April 22, 2020. Comparisons in clinical characteristics and laboratory data were made between those who survived and those who experienced in-hospital death; short term outcomes were reported. Results: Median age was 64.5 years; 61.4% were men and 88.6% were Black or Hispanic. One hundred and two (89.5%) patients had hypertension, 76 (66.7%) had diabetes mellitus, 63 (55.2%) had cardiovascular disease and 30% were nursing home residents. Intensive care unit (ICU) admission was required in 13.2% and 16.7% required mechanical ventilation. In-hospital death occurred in 28% of the cohort, 86.7% of those requiring ICU and nearly 100% of those requiring mechanical ventilation. A large number of in-hospital cardiac arrests were observed. Initial procalcitonin, ferritin, lactate dehydrogenase, C-reactive protein and lymphocyte percentage were associated with in-hospital death. Conclusions: Short term mortality in chronic hemodialysis patients hospitalized with COVID-19 was high. Outcomes in those requiring ICU and mechanical ventilation were poor, underscoring the importance of end-of-life discussions in ESKD patients hospitalized with severe COVID-19 and the need for heightened awareness of acute cardiac events in the setting of COVID-19. Elevated inflammatory markers were associated with in-hospital death in ESKD patients hospitalized with COVID-19.