COVID-19 in patients undergoing long-term dialysis in Ontario

Leena Taji; Doneal Thomas; Matthew J. Oliver; Jane Ip; Yiwen Tang; Angie Yeung; Rebecca Cooper; Andrew A. House; Phil McFarlane; Peter G. Blake

doi:10.1503/cmaj.202601

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Figure 1:
Flow chart for selection of the cohort of patients undergoing long-term dialysis in Ontario. Note: ORRS = Ontario Renal Reporting System, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
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Figure 2:
Number of new cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patients undergoing long-term dialysis in Ontario and the Ontario general population,2 per reporting week, as of Aug. 20, 2020. Note: We used 12 501 as the denominator for the dialysis population; peak incidence was 33 cases = 264 per 100 000 population for the week ending Apr. 23, 2020. We used 14 745 04014 as the denominator for the general Ontario population for this period; peak incidence was 3918 cases = 27 per 100 000 population for the week ending Apr. 23, 2020.
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Figure 3:
Summary of multivariable logistic regression predicting risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patients undergoing long-term dialysis (no. of patients with a diagnosis of SARS-CoV-2 infection = 187; no. without SARS-COV-2 infection = 12 246). Reference categories: age younger than 50 years, ethnicity White, geographic location outside the Greater Toronto Area (GTA), modality home dialysis, highest 2 income quintiles, 5 or fewer years undergoing dialysis, sex female and all other variables were No. Note: CI = confidence interval, OR = odds ratio. We excluded 68 patients from the cohort without SARS-CoV-2 infection because linkage to neighbourhood income quintiles was not possible.

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Table 1:

Clinical and demographic characteristics of patients undergoing long-term dialysis in Ontario with and without a diagnosis of SARS-CoV-2 infection, as of Aug. 20, 2020

Characteristic	No. (%) of patients with SARS-CoV-2 infection	No. (%) of patients without SARS-CoV-2 infection	Standardized difference, %^*
All patients	187 (NA)	12 314 (NA)
Modality			40
In-centre hemodialysis	166 (88.8)	9159 (74.4)
Home dialysis	21 (11.2)	3155 (25.6)
Years on dialysis			13
0–5	138 (73.8)	9754 (79.2)
> 5	49 (26.2)	2560 (20.8)
Resident of LTC			61
No	140 (74.9)	11 753 (95.4)
Yes	47 (25.1)	561 (4.6)
Geographic location			66
Greater Toronto Area	151 (80.7)	6293 (51.1)
Outside the Greater Toronto Area	36 (19.3)	6021 (48.9)
Sex			3
Female	72 (38.5)	4909 (39.9)
Male	115 (61.5)	7405 (60.1)
Age group, yr			6
18–49	25 (13.4)	1654 (13.4)
50–64	57 (30.5)	3427 (27.8)
≥ 65	105 (56.1)	7233 (58.7)
Age, yr			3
Median (IQR), yr	68 (58–78)	68 (57–77)
Range	20–92	18–102
Ethnicity			59
White	61 (32.6)	7265 (59.0)
Black	38 (20.3)	889 (7.2)
Indian subcontinent	24 (12.8)	1177 (9.6)
Other non-White	57 (30.5)	2675 (21.7)
Missing/unknown	7 (3.7)	308 (2.5)
Diabetes			3
Yes	86 (46.0)	5872 (47.7)
Cancer			7
Yes	10 (5.3)	856 (7.0)
Cardiac disease			2
Yes	53 (28.3)	3587 (29.1)
Previous transplant			13
Yes	7 (3.7)	807 (6.6)
Income quintiles^†			35
1 (lowest)	69 (36.9)	3639 (29.6)
2	49 (26.2)	2752 (22.3)
3	42 (22.5)	2348 (19.1)
4	15 (8.0)	1901 (15.4)
5 (highest)	12 (6.4)	1606 (13.0)
Missing/unknown	0 (0.0)	68 (0.6)

Note: IQR = interquartile range, LTC = long-term care, NA = not available, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
↵* Accepted criteria for determining a meaningful difference is a standardized difference greater than 10% and is indicated in boldface type.
↵† Income quintile is a measure of neighbourhood socioeconomic status that divides the population into 5 income groups of equal size in which group 1 lives in the neighbourhoods with the lowest incomes and group 5 in those with the highest incomes.