Impact of renal disease and comorbidities on mortality in hemodialysis patients with COVID-19: a multicenter experience
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EDITORIAL
Impact of renal disease and comorbidities on mortality in hemodialysis patients with COVID‑19: a multicenter experience from Germany Maximilian Seidel1 · Bodo Hölzer1 · Heiner Appel2 · Nina Babel1,3 · Timm H. Westhoff1 · The COVID Dialysis Working Group
© The Author(s) 2020
There is an increasing number of reports on the clinical course of Coronavirus disease 2019 (COVID-19) in hemodialysis patients [1–4]. On this background, we would like to report data on a large multicenter cohort of hemodialysis patients with COVID-19 in Germany, which demonstrates an inverse distribution of mild and severe courses compared to the general population. Through the analysis of the impact of underlying renal disease and cardiovascular comorbidities on adverse outcome, we could identify cardiorenal syndrome as an outstanding risk factor for death. Since the first cases of pneumonia of unknown origin were reported in December 2019 in Wuhan, knowledge on SARS-CoV-2 and COVID-19 is rapidly expanding. Preexisting cardiovascular disease, diabetes, hypertension, and chronic kidney disease were identified as risk factors for severe disease and mortality [5–7]. Thus, the hemodialysis population may be at outstanding risk for a severe course of COVID-19. Moreover, hemodialysis centers are prone to SARS-CoV-2 transmission. Patients have to refer to the outpatient facility three times per week to undergo dialysis and are thereby limited in their ability to social distance. As expected, mortality rates were substantially higher than in The members of the COVID Dialysis Working Group listed in acknowledgement section. * Timm H. Westhoff [email protected] 1
Medical Department I, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany
2
Dialysezentrum Hamm, Hamm, Germany
3
Center for Translational Medicine, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
the general population, ranging from 18.9 (Wuhan) to 52% (Lombardy) [1, 2]. Interestingly, the causes of death were frequently not directly related to pneumonia but to cardiovascular or cerebrovascular disease [1]. Although there was a shift to more critical courses of COVID-19, the spectrum of severity of COVID-19 was similar to the general population including several asymptomatic patients. It remains elusive which hemodialysis patients are at increased risk for adverse outcome. We would therefore like to add to the present knowledge by reporting on the clinical characterization of COVID19 in hemodialysis patients in Germany and identifying risk factors for adverse outcome. Five hemodialysis outpatient centers in Germany were contacted in April 2020 and asked to participate in the analysis. All of them agreed and provided clinical data of their hemodialysis patients with COVID-19 from February to April 2020. Data collection was performed by nephrologists from the outpatient centers and included both outpatient data and in-hospital data; analysis was centralized at a Un
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