Home dialysis reduces COVID-19 exposure, may prevent future infection transmission
After finding that patients who received dialysis in-center had higher rates of COVID-19, researchers advocated for “a major shift” to home-based care as a means to reduce the risk for transmission of future infectious diseases.
“We found a lower burden of COVID-19 infection, hospitalization, mortality, and ICU admission in community-dwelling home dialysis [vs.] in-center patients. Our findings may relate to greater case finding in the in-center population, more frequent health care encounters, and routine screening/outbreak surveillance, which was at the program’s discretion,” Jeffrey Perl, MD, FRCP(C), SM, of the University of Toronto and St. Michael’s Hospital, and colleagues wrote. “If increased testing among in-center [hemodialysis] HD patients was the only explanation for the higher rates of COVID-19, one would have expected a disproportionate excess of milder cases (ie, SARS-CoV-2 positivity not requiring hospital admission) among in-center compared with home dialysis patients. However, among in-center HD patients, we also observed higher rates of COVID-19 hospitalization, mortality, and ICU admission that may have been due to a higher infection rate rather than greater case-associated morbidity.”
With an observation period stemming from March 2020 to November 2020, Perl and colleagues identified 3,622 patients receiving home dialysis and 9,890 patients receiving in-center treatments.
Investigators found SARS-CoV-2 testing rates were lower for patients on home dialysis vs. in-center dialysis (adjusted rate ratio = 0.37), and that patients treated at home had lower positive SARS-CoV-2 tests and COVID-19 hospitalization rates.
Among patients infected with COVID-19, researchers observed no differences between groups in the adjusted odds of hospitalization and ICU admission or 30-day mortality.
“In the United States, rates of home dialysis continue to increase following the introduction of favorable reimbursement and policy reform,” Perl and colleagues concluded. “In addition to other purported benefits, a major shift to home-based dialysis care could render the [end-stage kidney disease] ESKD population more resilient to the effects of COVID-19, reducing exposure episodes and total exposure time to SARS-CoV-2 while conferring lower future exposure risks to highly transmissible infections.”