High mortality of CKD patients on hemodialysis with Covid-19 in Brazil
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EDITORIAL
High mortality of CKD patients on hemodialysis with Covid‑19 in Brazil Andrea Pio‑Abreu1 · Marcelo Mazza do Nascimento2 · Marcos Alexandre Vieira3 · Precil Diego Miranda de Menezes Neves1 · Jocemir Ronaldo Lugon4 · Ricardo Sesso5
© Italian Society of Nephrology 2020
The first case of the novel coronavirus disease (Covid-19) pandemic in Brazil was reported on February 26th, 2020, in São Paulo. On June 30th, Brazil ranked 2nd in the world in the number of cases, with 1.4 million victims officially reported and an average number of 37,600 new cases per day [Coronavirus disease case panel 2019 (COVID-19) in Brazil by the Ministry of Health. Available at: https://covid.saude .gov.br/. Accessed June 27, 2020.]. Brazil is the third country in the world in the number of patients on chronic dialysis, with 133,500 in July, 2018 [2]. Ninety-two percent of them are on in-center hemodialysis (HD). A large number of kidney disease patients particularly those with kidney failure on dialysis are at a higher risk of complications of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection [3, 4]. The Brazilian Society of Nephrology, in conjunction with the Brazilian Association of Dialysis and Transplant Centers, has been conducting a national on-line survey of Covid-19 on kidney failure patients undergoing regular HD, since June 1st, 2020. In the present study, we describe the incidence, mortality, and fatality rates due to Covid-19 since the beginning of the outbreak until June 30th in a sample of 37,852 hemodialysis patients. Cases were considered confirmed if they had laboratory isolation of the SARS-CoV-2 by RT-PCR test from nasopharyngeal/oropharyngeal swabs. As of June 30th, there were 1,402,041 cases and 59,594 deaths reported in the overall Brazilian population [1, 5]. * Andrea Pio‑Abreu [email protected] 1
Nephrology Division, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
2
Universidade Federal do Paraná, Curitiba, PR, Brazil
3
Associação Brasileira dos Centros de Dialise e Transplante, Brasília, Brazil
4
Universidade Federal Fluminense, Niteroi, RJ, Brazil
5
Universidade Federal de São Paulo, São Paulo, SP, Brazil
Two hundred and seven dialysis centers, representing 26% of the 805 Brazilian centers responded to the survey. These centers derived from 24 of the 27 Brazilian states and their distribution by region was similar to that in all the Brazilian states (6% North, 16% Northeast, 8% Midwest, 51% Southeast, and 19% South). Likewise, the nature of the centers (73% private, and 27% public) and the predominant funding by the Brazilian public health system (80%) instead of private (20%) were similar to those of general centers in the country [2]. The total number of HD patients in the study centers was 37,852. Of these, 1291 were confirmed for Covid-19, and 357 died. The incidence, mortality, and fatality rates in HD patients were 341/10,000 patients, 94/10,000 patients, and 27.7%, respectively (Table 1). The number of Covid-19 patients,
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