Kidney dialysis patients 40 times more likely to be hospitalized with COVID

COVID-19 hospitalization and all-cause death rates for patients with end-stage kidney disease undergoing dialysis, as well as kidney transplant recipients, climbed steeply early in the pandemic, and both exhibited racial disparities, according to a study published yesterday in the Journal of the American Society of Nephrology (JASN).

Researchers at Hennepin Healthcare Research Institute in Minneapolis retrospectively analyzed data from the Centers for Medicare & Medicaid Services Renal Management Information System before and after the emergence of COVID-19.

The investigators found that when the hospitalization rate for COVID-19 patients undergoing dialysis peaked from Mar 22 to Apr 25, 2020, it was 40 times higher than that of the rest of the population. And the risk of death from any cause was 17% higher among those on dialysis and 30% higher among kidney transplant recipients from Mar 22 to Jul 4, 2020, than during corresponding periods in 2017 to 2019.

Black and Hispanic patients had particularly high hospitalization rates, while those undergoing at-home dialysis had lower rates than those receiving their treatments in clinics. Dialysis patients were also hospitalized 17% less often than usual for reasons other than coronavirus during the pandemic.

The authors noted that roughly 800,000 people on dialysis or living with a kidney transplant in the United States are at higher risk for COVID-19 because many visit clinics multiple times each week for dialysis or, in the case of transplant recipients, take drugs to prevent organ rejection that make them susceptible to infection.

First author Eric Weinhandl, PhD, said in an American Society of Nephrology news release that the first phase of the pandemic had “profound” effects on kidney patients. “With markedly higher rates of all-cause mortality in both dialysis and kidney transplant patients during the second quarter of 2020, there is now a clear rationale for prioritization of kidney failure patients in COVID-19 vaccination schedules promulgated by states,” he said.
Apr 8 JASN study
Apr 8 American Society of Nephrology news release

Emergency staff report high stress levels during pandemic

A study in Annals of Emergency Medicine shows that emergency staff reported signs of substantial anxiety, burnout, and post-traumatic stress disorder (PTSD) during the summer months of the COVID-19 pandemic.

Researchers from the University of California San Francisco (UCSF) led the study, based on responses from 1,600 emergency department staff, including physicians, nurses, advanced practice providers, social workers, and other personnel at 20 emergency departments across the country. The study was conducted from May through July 2020.

The participants in the study were tested for COVID-19 via nasal swab polymerase chain reaction and serum antibody tests and then completed a survey. Respondents said their biggest concern during the first weeks of the pandemic was exposing their families or others to the virus.

The authors found that 19.2% of emergency staff were at risk for PTSD, and 46% reported symptoms of emotional exhaustion and burnout from their work. Female respondents were more likely than males to screen positive for increased stress, the authors found (odds ratio, 2.03; 95% confidence interval, 1.49 to 2.78).

Providing antibody serology tests and learning their immune status decreased anxiety among 54% of participants.

“As the nation moves into what many believe is a fourth wave of COVID, this study is important to our understanding of the impact of the pandemic on the mental well-being of frontline medical personnel,” said lead author Robert M. Rodriguez, MD, a professor of Emergency Medicine at UCSF in a press release.

“Considering the relatively high levels of burnout symptoms, and that more than half of participants reported experiencing at least one symptom of PTSD and as many as 20 percent were at higher risk, employers should encourage workers to take time off, get adequate rest and utilize available well-being resources,” said Rodriguez.
Apr 9 UCSF press release
Feb 4 Ann Emerg Med study