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The COVID-19 pandemic has been a global public health problem. Latin America has had the highest mortality rates worldwide, with over 1.8 million deaths as of October 2023. Patients with end-stage renal disease have an increased risk of infection and mortality than the general population. Several national and international initiatives were created during the pandemic to support these patients, including obtaining relevant clinical data to potentiate public health initiatives. Our objective is to evaluate the impact of the SARS-CoV-2 pandemic in Latin America and to compare ESRD patients versus the general population in different countries.
Multinational observational study performed in the Southern Cone of Latin America (Argentina, Chile, and Uruguay). Individual patient data of ESRD patients in hemodialysis and peritoneal dialysis were collected by their respective national nephrologist societies, including incidence of SARS-CoV-2 infection, severe COVID-19 (defined as hospitalizations and deaths), and COVID-related deaths. Data from the general population was obtained through national follow-up of patients by the Ministries of Health. We evaluated patients during 2020 and 2021 up to the initiation of COVID-19 vaccine administration. We determined predictors of severe COVID-19 in the different countries by calculating odds ratios.
Our study included 53.444 ESRD patients and 68.264.159 subjects of the general population in the Southern Cone. During follow-up, 5,428 patients developed COVID-19, and 1,212 had COVID-related deaths. The mean infection rate during 2020 was 10.1% in ESRD patients versus 4.1% in the general population (odds ratio: 2.46 [2.39-2.53]), and the mortality rate was 22.3% in ESRD patients versus 2.5% in the general population (odds ratio: 8.9 [8.3-9.4]; Table 1). In addition to ESRD, higher age was the most relevant predictor of adverse outcomes in all populations, with an increase in mortality rate from 0.1% in people below 40 years to 41% in patients above 80 years (Figure 1).
This is the first multinational observational study that reports the massive impact of the SARS-CoV-2 pandemic on ESRD patients in the Southern Cone of Latin America. The similarity in the incidence and mortality curves both in the general population and in HD patients is striking, which may be related to similar health policies in the 3 countries with universal access to health, as well as to renal replacement treatment. Additional studies will evaluate the impact of public health interventions, including vaccination, to improve clinical outcomes in this population.