Clinical characteristics and risk factors associated with 28-day mortality among maintenance hemodialysis patients infected with Omicron variant of SARS-CoV-2.

INTRODUCTION: The SARS-CoV-2 variant of concern (VOC), Omicron, is characterized by lower virulence and pathogenicity, yet it exhibits high infectivity. Data on Omicron COVID-19 in maintenance hemodialysis (MHD) are scarce. In the present study, we aimed to investigate the clinical characteristics, outcomes and risk factors associated with 28-day mortality among these patients with COVID-19 infections. METHODS: We conducted a retrospective analysis of data from 211 MHD patients infected with the SARS-CoV-2 Omicron variant. These patients, from ten dialysis centers across Shanghai, were consecutively admitted to our designated hospital from March 28, 2022, to June 18, 2022. We compared demographics and clinical characteristics within 48 h of hospitalization between patients who survived and those who did not. RESULTS: The 28-day mortality rate was 9.5%. A Cox multivariate regression analysis identified several predictors of 28-day mortality: pre-existing cardiovascular disease (hazard ratio [HR] 8.09, 95% confidence interval [CI] 2.66-24.62, P < 0.001), elevated C reactive protein level (HR 1.00, 95% CI 1.00-1.01, P = 0.015), high interleukin-6 (IL-6) level (≥ 21.6 pg/ml, HR 8.52, 95% CI 1.09-66.42, P = 0.041), and high N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (≥ 35000 pg/ml, HR 3.56, 95% CI 1.11-11.44, P = 0.033). Combining these four parameters may serve as a valuable tool for identifying MHD patients at high risk of 28-day mortality. CONCLUSION: Pre-existing cardiovascular diseases and inflammatory storm were risk factors for critical COVID-19 or death in MHD patients. Special attention and an appropriate level of care are necessary for these high-risk hemodialysis patients. CLINICAL TRIAL: Not applicable.