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

Background. 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. Methods. We developed risk prediction models for COVID-19 incidence and mortality among HD patients. We studied 38 256 HD 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 HD units. We compared mortality among patients with and without COVID-19, matched for age, sex and diabetes. Results. 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 with odds ratios 219.8 [95% confidence interval (CI) 80.6-359] to 342.7 (95% CI 60.6-13 595.1), 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 [N = 22 826 area under the ROC curve(AUC) (Dev) 0.64, AUC(Val) 0.69]. The model for prediction of mortality was developed in all COVID-19 patients (AUC(Dev) 0.71, AUC(Val) 0.78). Angiotensin receptor blockers were independently associated with a lower incidence of COVID-19 in European patients. Conclusions. We identified modifiable risk factors for COVID-19 incidence and outcome in HD patients. Our 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.

Automated summary

The study developed and validated risk prediction models for COVID-19 incidence and mortality in hemodialysis patients, identifying modifiable risk factors and the association of angiotensin receptor blockers with lower COVID-19 incidence. These tools can be readily applied in clinical practice to aid in the development of preventive strategies for future waves of COVID-19.