Several Risks Factors for COVID-19 Recorded in Dialysis Patients


Investigators also noted that higher rates of infection were observed in Black patients.

Richard A. Hirth, PhD

Richard A. Hirth, PhD

A recent cohort study from Michigan found several risk factors for COVID-19 that persisted as mortality risk factors among Medicare patients receiving regular maintenance dialysis.

Among these risks were nursing home status, time on dialysis, congestive heart failure, diabetes, and comorbidity burden.

Additionally, higher rates for the virus were observed among Black patients in the study, though attenuated survival differences were observed between Black and non-Black patients.

Investigators led by Richard A. Hirth, PhD, University of Michigan School of Public Health, cited a need for studies to evaluate such risk factors among the entire Medicare long-term dialysis population through Medicare claims data.

The Methods

Hirth and colleagues based their retrospective, claims-based cohort study on contractual work that was performed for the Centers for Medicare & Medicaid Services (CMS) to support kidney disease quality measure development and maintenance.

The study population was formed by all Medicare patients who received long-term dialysis in 2020 that were derived from the CMS clinical and administrative databases.

Patients were considered to be on Medicare if they were enrolled in Medicare Advantage, had at least $1200 in Medicare-paind dialysis claims, or had 1 or more Medicare inpatient claims in a given month or the 2 prior months.

Patients in this group would be followed on January 1, 2020, and for at least 90 days after.

From there, investigators compared mortality trends in 2020 with historic trends that were detailed from 2013 to 2019. The ream derived monthly empirical hazards for all-cause mortality including number of deaths and number at risk.

Being at risk was defined as being a Medicare patient, assigned to a facility, and receiving dialysis, while for a patient death to be attributed to the mortality hazards, the patient must have been at risk on the day they died.

From there, COVID-19 diagnoses were identified through inpatient, outpatient, skilled nursing, home health, hospice, and physician/supplier claims.

Several patient demographic and clinical characteristics were identified by the patients’ medical evidence forms including age, sex, race, ethnicity, body mass index, years receiving dialysis and 13 comorbidities at end-stage-kidney disease (ESKD).

The Findings

Among the 498,169 Medicare patients undergoing dialysis, 60,090 (12.1%) had been infected with the COVID-19 virus during the study.

Investigators noted that COVID-19 rates were higher among Black (21 787 of 165 830 Black patients [13.1%] vs 38 303 of 332 339 non-Black patients [11.5%]) and Hispanic (13 530 of 86 871 Hispanic [15.6%] vs 46 560 of 411 298 non-Hispanic patients [11.3%]) patients.

They added that the most prominent differences in COVID-19 rates were observed between patients with short nursing home stays and extended nursing home stays compared with patients who did not receive nursing home care in the prior year (14%, 35.6%, and10.1%, respectively).

Residing in a nursing home 1 to 89 days in the prior year was associated with a higher hazard for COVID-19 (hazard ratio [HR] vs 0 days, 1.60; 95% CI 1.56-1.65) and for postdiagnosis mortality (HR, 1.31; 95% CI, 1.25-1.37), when adjusting for all risk factors.

Residing in a nursing home for an extended stay was also associated with increased risk of infection.

Finally, home dialysis was associated with higher mortality as well as lower COVID-19 rates.

To our knowledge, this cohort study is the first national study using CMS claims data to evaluate COVID-19 outcomes in the Medicare dialysis population using all available 2020 data through December 2020,” the team wrote. “These results improve our understanding of COVID-19 and complications in this high-risk population and could inform policy decisions to mitigate the added burden of COVID-19 and death.”

The study, “COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis,” was published online in JAMA Open Network.

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