Hemoperfusion Is Associated with Reduced Mortality in Outpatient Maintenance Hemodialysis Patients with COVID-19

Background: High mortality rates have been observed in patients with COVID-19 undergoing maintenance hemodialysis, potentially attributable to exacerbated inflammatory responses. Hemoperfusion, a therapeutic technique based on adsorption for removing inflammatory mediators, presents a promising therapeutic approach. However, its efficacy in improving outcomes for this patient population remains to be established. Methods: This was a single-center retrospective cohort study conducted from December 7, 2022, to May 24, 2023, following the cancellation of the 'Dynamic Zero-COVID’ policy during the Omicron variant surge. Patients with COVID-19 were stratified based on their hemoperfusion treatment status. We investigated all-cause mortality as the primary outcome, using adjusted Cox regression analysis. The risk of hospitalization, our secondary outcome, was examined through logistic regression models. Results: Among the 224 patients who met the eligibility criteria, 118 (52.7%) underwent hemoperfusion treatment. The cohort's mean age was 62.8 ± 13.1 years, predominantly male (71.0%), with 89.3% lacking prior immunity to SARS-CoV-2. Over a 120-day follow-up, 25 patients succumbed, with mortality rates of 18.9% (20 patients) in the control group compared to 4.2% (5 patients) in the hemoperfusion group (p=0.001). Hemoperfusion was significantly associated with a reduced risk of all-cause mortality (HR, 0.234; 95% CI, 0.079 to 0.696; p=0.012) and hospitalization (OR, 0.423; 95% CI, 0.196 to 0.917; p=0.029), compared to controls. Additionally, the hemoperfusion group exhibited significantly lower mean changes in CRP, D-dimer, and serum ferritin levels than the control group within one month after COVID-19. Conclusion: Hemoperfusion treatment in patients with COVID-19 on maintenance hemodialysis was linked to a decreased risk of all-cause mortality and a reduced in early inflammatory markers. These findings suggest that hemoperfusion may be a beneficial therapeutic strategy for COVID-19 management in the hemodialysis population, meriting further exploration.