Systematic Review and Meta-Analysis of the Impact of COVID-19 on Dialysis Outcomes

Concerns have been raised regarding the impact of COVID-19, which is produced by the SARS-CoV-2 virus, on vulnerable groups, such as those receiving continuous dialysis for end-stage renal disease (ESRD). This systematic review and meta-analysis aim to comprehensively synthesize the existing evidence on the relationship between COVID-19 and dialysis outcomes. Following PRISMA and MOOSE guidelines, a systematic literature search was conducted across major databases to identify relevant studies published up to the date of the search initiation. Inclusion criteria encompassed studies reporting outcomes of COVID-19 in individuals undergoing chronic dialysis, and a standardized data extraction form was used to capture essential information.

In individuals with HD, the incidence of COVID-19 was 7.7% (95% CI: 5.0–10.9%), exhibiting notable heterogeneity (I2 = 99.7%, p < 0.001). Clinical manifestations included fever (61.4%), cough (46.8%), dyspnea (35.2%), and fatigue (35.2%). Bilateral lung involvement with ground-glass opacities was prevalent radiologically, with 10–50% of patients showing negative results. Among the patients, the death rate was 22.4% (95% CI: 17.9-27.1%); nevertheless, there was a notable degree of heterogeneity among the trials (I2=83.2%, P=0.001). Causes of mortality, often unreported, included respiratory failure (mainly due to ARDS), cardiac arrest, sepsis, and hyperkalemia. This study highlights the vulnerability of HD patients to COVID-19, with a notable incidence and mortality rate. The findings emphasize the importance of standardized treatment protocols and further research to guide evidence-based care for this high-risk population.