Mortality associated with the COVID-19 pandemic in the Swiss dialysis population beyond SARS-CoV-2 infection

David A Jaques; Linard Hoessly; Rebecca Guidotti; Michael Koller; Belen Ponte; Patrice Ambuehl

doi:10.1093/ckj/sfae322

Mortality associated with the COVID-19 pandemic in the Swiss dialysis population beyond SARS-CoV-2 infection

Clin Kidney J. 2024 Oct 29;17(12):sfae322. doi: 10.1093/ckj/sfae322. eCollection 2024 Dec.

Authors

David A Jaques¹, Linard Hoessly², Rebecca Guidotti³, Michael Koller², Belen Ponte¹, Patrice Ambuehl³

Affiliations

¹ Department of Medicine, Division of Nephology and Hypertension, Geneva University Hospitals, Geneva, Switzerland.
² Department of Circulation, Thorax and Transplantation, Clinic for Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland.
³ Institute of Nephrology, City Hospital Zurich, Zurich, Switzerland.

Abstract

Background: While SARS-CoV-2 infection has direct obvious consequences on patients undergoing dialysis, the COVID-19 pandemic also had an indirect impact on health systems. Therefore, we aimed to determine whether the COVID-19 era itself was associated with adverse consequences in the Swiss dialysis population as compared to the pre-COVID-19 era, while accounting for direct impact of SARS-CoV-2 infection.

Methods: We retrospectively included all patients recorded in the Swiss dialysis registry from January 2014 to December 2022. The pre-COVID-19 era and the COVID-19 era were defined based on the cut-off date of January 2020. Cox proportional hazard model was used with all-cause mortality as the primary outcome.

Results: The cohort consisted of 7837 patients from 97 dialysis centres. Median age was 68.6 years with 66.1% men. Crude mortality rates were 11.6% (11.0% to 12.2%) and 14.2% (13.4% to 14.9%) person-years for the pre-COVID-19 era and the COVID-19 era, respectively. In multivariable analysis, SARS-CoV-2 infection was associated with an increased risk of mortality (HR 4.26, 95% CI 3.65 to 4.97, P < .001) while the COVID-19 era itself was not (HR 0.98, 95% CI 0.88 to 1.08, P = .687).

Conclusions: The COVID-19 era was not associated with an excess of mortality in the Swiss dialysis population as compared to the pre-COVID-19 era when accounting for the direct effect of SARS-CoV-2 infection. This suggests that control measures established during the pandemic did not have a negative impact on dialysis patients at the national level. These results could inform health policy makers in the eventuality of future pandemics.

Keywords: COVID-19; SARS-CoV-2 infection; control measures; dialysis; mortality.