Author:
Delfino-Pereira Polianna,Ventura Vanessa das Graças José,Pires Magda Carvalho,Ponce Daniela,Carmo Gabriel Assis Lopes do,Carmo Lilian Pires de Freitas do,Paiva Bruno Barbosa Miranda de,Schwarzbold Alexandre Vargas,Gomes Angélica Gomides dos Reis,Castro Bruno Mateus de,Polanczyk Carísi Anne,Cimini Christiane Corrêa Rodrigues,Lima Daniela Antunes de,Sousa Fabiano Carvalho de,Bartolazzi Frederico,Vietta Giovanna Grunewald,Vianna Heloisa Reniers,Chatkin José Miguel,Ruschel Karen Brasil,Kopittke Luciane,Castro Luís César de,Carneiro Marcelo,Reis Priscilla Pereira dos,Marcolino Milena Soriano
Abstract
Patients with chronic kidney disease (CKD), especially those on dialysis or who have received a kidney transplant (KT), are considered more vulnerable to severe COVID-19. This susceptibility is attributed to advanced age, a higher frequency of comorbidities, and the chronic immunosuppressed state, which may exacerbate their susceptibility to severe outcomes. Therefore, our study aimed to compare the clinical characteristics and outcomes of COVID-19 in KT patients with those on chronic dialysis and non-CKD patients in a propensity score-matched cohort study. This multicentric retrospective cohort included adult COVID-19 laboratory-confirmed patients admitted from March/2020 to July/2022, from 43 Brazilian hospitals. The primary outcome was in-hospital mortality. Propensity score analysis matched KT recipients with controls - patients on chronic dialysis and those without CKD (within 0.25 standard deviations of the logit of the propensity score) - according to age, sex, number of comorbidities, and admission year. This study included 555 patients: 163 KT, 146 on chronic dialysis, and 249 non-CKD patients (median age 57 years, 55.2% women). With regards to clinical outcomes, chronic dialysis patients had a higher prevalence of acute heart failure, compared to KT recipients, furthermore, both groups presented high in-hospital mortality, 34.0 and 28.1%, for KT and chronic dialysis patients, respectively. When comparing KT and non-CKD patients, the first group had a higher incidence of in-hospital dialysis (26.4% vs. 8.8%, p < 0.001), septic shock (24.1% vs. 12.0%, p = 0.002), and mortality (32.5% vs. 23.3%, p = 0.039), in addition to longer time spent in the intensive care unit (ICU). In this study, chronic dialysis patients presented a higher prevalence of acute heart failure, compared to KT recipients, whereas KT patients had a higher frequency of complications than those without CKD, including septic shock, dialysis during hospitalization, and in-hospital mortality as well as longer time spent in the ICU.