Sex differences in COVID-19 symptoms and outcomes in people with kidney failure treated with dialysis: a prospective cohort study

Tyrone G Harrison; Trinity A Tam; Meghan J Elliott; Sofia B Ahmed; Victoria Riehl-Tonn; Asha K R Swamy; Jamie L Benham; Joanne Peterson; Jennifer M MacRae

doi:10.1007/s40620-022-01448-0

Sex differences in COVID-19 symptoms and outcomes in people with kidney failure treated with dialysis: a prospective cohort study

J Nephrol. 2023 Apr;36(3):851-860. doi: 10.1007/s40620-022-01448-0. Epub 2022 Sep 10.

Authors

Tyrone G Harrison^{1

2}, Trinity A Tam¹, Meghan J Elliott^{1

2}, Sofia B Ahmed^{1

3}, Victoria Riehl-Tonn¹, Asha K R Swamy¹, Jamie L Benham^{1

2}, Joanne Peterson⁴, Jennifer M MacRae^{5

6

7

8}

Affiliations

¹ Department of Medicine, University of Calgary, Calgary, AB, Canada.
² Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
³ Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁴ Alberta Health Services, Alberta, Canada.
⁵ Department of Medicine, University of Calgary, Calgary, AB, Canada. jmmacrae@ucalgary.ca.
⁶ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. jmmacrae@ucalgary.ca.
⁷ Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. jmmacrae@ucalgary.ca.
⁸ Departments of Medicine and Cardiac Sciences, Alberta Kidney Care South, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. jmmacrae@ucalgary.ca.

Abstract

Background: People with kidney failure treated with dialysis are at increased risk of SARS-CoV-2 infection, and severe COVID-19 outcomes such as hospitalization and death. Though there are well-defined sex differences in outcomes for the general population with COVID-19, we do not know whether this translates into kidney failure populations. We aimed to estimate the differences in COVID-19 symptoms and clinical outcomes between males and females treated with maintenance dialysis.

Methods: In this prospective observational cohort study, we included adults treated with maintenance dialysis in Southern Alberta, Canada that tested positive for COVID-19 between March 2020 and February 2022. We examined the association between sex (dichotomized as male and female) with COVID-19 symptoms including fever, cough, malaise, shortness of breath, muscle joints/aches, nausea and/or vomiting, loss of appetite, diarrhea, headache, sore throat, and loss of smell/taste using chi-square or Fisher's exact tests. Secondary outcomes included 30-day hospitalization, ICU admission, and death.

Results: Of 1,329 cohort participants, 246 (18.5%) tested positive for SARS-CoV-2 and were included in our study, including 95 females (39%). Of 207 participants with symptoms assessed, females had less frequent fever (p = 0.003), and more nausea or vomiting (p = 0.003) compared to males, after correction for multiple testing. Males exhibited no symptoms 25% of the time, compared with 10% of females (p = 0.01, not significant when corrected for multiple testing). We did not identify statistically significant differences in clinical outcomes between the sexes, though vaccinated patients had lower odds of hospitalization.

Conclusions: Sex differences in COVID-19 symptoms were identified in a cohort of patients treated with maintenance dialysis, which may inform sex-specific screening strategies in dialysis units. Further work is necessary to examine mechanisms for identified sex differences.

Keywords: COVID-19; Dialysis; Kidney failure; SARS-CoV-2; Sex.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alberta
COVID-19*
Female
Humans
Male
Prospective Studies
Renal Dialysis
Renal Insufficiency*
SARS-CoV-2
Sex Characteristics