The Impact of COVID-19 on Post-Discharge Outcomes for Dialysis Patients in the United States: Evidence from Medicare Claims Data

Abstract

Background: Recent investigations have shown that on average patients hospitalized with coronavirus disease 2019 (COVID-19) have a poorer post-discharge prognosis than those hospitalized without COVID-19, but this impact remains unclear among dialysis patients with end-stage kidney disease (ESKD). Methods: Leveraging a national ESKD patient claims database administered by the United States Centers for Medicare & Medicaid Services, we conducted a retrospective cohort study, which characterized the effects of in-hospital COVID-19 on all-cause unplanned readmission and death within 30 days of discharge for dialysis patients. Included in this study were 436,745 live acute-care hospital discharges of 222,154 Medicare beneficiaries on dialysis from 7,871 Medicare-certified dialysis facilities between January 1, 2020 and October 31, 2020. Adjusting for patient demographics, clinical characteristics, and prevalent comorbidities, we fit facility-stratified Cox cause-specific hazard models with two interval-specific (1-7 and 8-30 days after hospital discharge) effects of in-hospital COVID-19 as well as effects of pre-hospitalization COVID-19. Results: The hazard ratios due to in-hospital COVID-19 over the first 7 days following discharge were 1.59 for readmission and 1.53 for death, both with P<0.001. For the remaining 23 days, the hazard ratios were 0.92 and 0.96 with P<0.001 and P=0.50, respectively. Effects of pre-hospitalization COVID-19 were mostly nonsignificant. Conclusions: In-hospital COVID-19 had an adverse effect on both post-discharge readmission and death over the first week. With the surviving COVID-19 patients substantially selected from those hospitalized, in-hospital COVID-19 was associated with lower rates of readmission and death starting from the second week.