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Background <p>Although the SARS-CoV-2 Omicron variant demonstrates lower mortality than previous variants in the general population, its impact on patients with end-stage kidney disease (ESKD) remains concerning. Substantial mortality has been reported in patients with ESKD during the Omicron period; however, comparing this with influenza mortality could provide insights into COVID-19’s true impact in this high-risk population.</p> Methods <p>Using the National Database of Health Insurance Claims of Japan, we conducted a retrospective cohort study of hemodialysis patients diagnosed with COVID-19 during the Omicron period (January 2022-March 2023) or influenza (September 2017-March 2023). The primary outcome was 30-day all-cause mortality. Overlap weighting based on propensity scores balanced confounding factors.</p> Results <p>We identified 53,047 COVID-19 and 35,808 influenza cases. After overlap weighting, the 30-day mortality rates were 3.4% for COVID-19 and 1.8% for influenza (hazard ratio [HR] 1.61 [95% CI 1.47, 1.77]). In subgroup analyses stratified by age, HRs were comparable across all age groups (20–49&#xa0;years: 1.59 [0.81, 3.13]; 50–59&#xa0;years: 1.43 [0.94, 2.17]; 60–69&#xa0;years: 1.45 [1.15, 1.84]; 70–79&#xa0;years: 1.68 [1.43, 1.96]; ≥ 80&#xa0;years: 1.66 [1.45, 1.89]). The absolute risk differences (per 1,000 patients) across age groups were 1.7, 2.6, 6.2, 16.2, and 28.9 deaths, respectively.</p> Conclusions <p>In this nationwide study, COVID-19 Omicron variant was associated with significantly higher mortality than influenza in hemodialysis patients. Age-stratified analyses showed consistent relative risks but progressively larger absolute risk differences in older patients.</p>

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Mortality comparison between the COVID-19 Omicron variant and influenza among patients with end-stage kidney disease: a nationwide population-based retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Tomoyuki Fujikura,
  • Koichi Miyashita,
  • Hironao Hozumi,
  • Yuri Ishino,
  • Naoko Katahashi,
  • Naoko Tsuji,
  • Sayaka Ishigaki,
  • Takamasa Iwakura,
  • Shinsuke Isobe,
  • Kazuki Furuhashi,
  • Naro Ohashi,
  • Toshiyuki Ojima,
  • Takafumi Suda,
  • Hideo Yasuda

摘要

Background

Although the SARS-CoV-2 Omicron variant demonstrates lower mortality than previous variants in the general population, its impact on patients with end-stage kidney disease (ESKD) remains concerning. Substantial mortality has been reported in patients with ESKD during the Omicron period; however, comparing this with influenza mortality could provide insights into COVID-19’s true impact in this high-risk population.

Methods

Using the National Database of Health Insurance Claims of Japan, we conducted a retrospective cohort study of hemodialysis patients diagnosed with COVID-19 during the Omicron period (January 2022-March 2023) or influenza (September 2017-March 2023). The primary outcome was 30-day all-cause mortality. Overlap weighting based on propensity scores balanced confounding factors.

Results

We identified 53,047 COVID-19 and 35,808 influenza cases. After overlap weighting, the 30-day mortality rates were 3.4% for COVID-19 and 1.8% for influenza (hazard ratio [HR] 1.61 [95% CI 1.47, 1.77]). In subgroup analyses stratified by age, HRs were comparable across all age groups (20–49 years: 1.59 [0.81, 3.13]; 50–59 years: 1.43 [0.94, 2.17]; 60–69 years: 1.45 [1.15, 1.84]; 70–79 years: 1.68 [1.43, 1.96]; ≥ 80 years: 1.66 [1.45, 1.89]). The absolute risk differences (per 1,000 patients) across age groups were 1.7, 2.6, 6.2, 16.2, and 28.9 deaths, respectively.

Conclusions

In this nationwide study, COVID-19 Omicron variant was associated with significantly higher mortality than influenza in hemodialysis patients. Age-stratified analyses showed consistent relative risks but progressively larger absolute risk differences in older patients.