COVID-19-related mortality in kidney transplant and haemodialysis patients: a comparative, prospective registry-based study
Author:
Goffin Eric1, Candellier Alexandre12, Vart Priya3, Noordzij Marlies3, Arnol Miha4, Covic Adrian5, Lentini Paolo6, Malik Shafi7, Reichert Louis J8, Sever Mehmet S9, Watschinger Bruno10, Jager Kitty J11, Gansevoort Ron T3, van der Net Jeroen B, Essig Marie, du Buf-Vereijken Peggy W G, van Ginneken Betty, Vogt Liffert, van Jaarsveld Brigit C, Bemelman Frederike J, Klingenberg-Salahova Farah, Heenan-Vos Frederiek, Vervloet Marc G, Nurmohamed Azam, Abramowicz Daniel, Verhofstede Sabine, Maoujoud Omar, Malfait Thomas, Avitum B Braun, Fialova Jana, Melilli Edoardo, Favà Alexandre, Cruzado Josep M, Perez Nuria Montero, Lips Joy, Krepel Harmen, Adilovic Harun, Hengst Maaike, Rydzewski Andrzej, Gellert Ryszard, Oliveira João, Alferes Daniela G, Zakharova Elena V, Ambuehl Patrice Max, Walker Andrea, Winzeler Rebecca, Lepeytre Fanny, Rabaté Clémentine, Rostoker Guy, Marques Sofia, Azasevac Tijana, Katicic Dajana, ten Dam Marc, Krüger Thilo, Brzosko Szymon, Zanen Adriaan L, Logtenberg Susan J J, Fricke Lutz, Slebe Jeroen J P, Kemlin Delphine, van de Wetering Jacqueline, Reinders Marlies E J, Eiselt Jaromir, Kielberger Lukas, El-Wakil Hala S, Verhoeven Martine A M, Canal Cristina, Facundo Carme, Ramos Ana M, Debska-Slizien Alicja, Veldhuizen Nicoline M H, Tigka Eirini, Konsta Maria Anna Polyzou, Panagoutsos Stylianos, Mallamaci Francesca, Matceac Irina, Nistor Ionut, Cordos Monica, Groeneveld J H M, Jousma Jolanda, van Buren Marjolijn, ElHafeez Samar Abd, Diekmann Fritz, Pereira Tiago Assis, Santos Augusto Cesar S, Arias-Cabrales Carlos, Crespo Marta, Llinàs-Mallol Laura, Buxeda Anna, Tàrrega Carla Burballa, Redondo-Pachon Dolores, Jimenez Maria Dolores Arenas, Hofstra Julia M, Franco Antonio, Arroyo David, Rodríguez-Ferrero Maria Luisa, Manzanos Sagrario Balda, Barrios R Haridian Sosa, Ávila Gonçalo, Laranjinha Ivo, Mateus Catarina, Lemahieu Wim, Dirim Ahmet Burak, Demir Erol, Şafak Seda, Turkmen Aydin, Hollander Daan A M J, Büttner Stefan, de Vries Aiko P J, Meziyerh Soufian, van der Helm Danny, Mallat Marko, Bouwsma Hanneke, Sridharan Sivakumar, Petruliene Kristina, Maloney Sharon-Rose, Verberk Iris, van der Sande Frank M, Christiaans Maarten H L, Hemmelder Marc, N Mohan Kumar, Di Luca Marina, Tuğlular Serhan Z, Kramer Andrea, Beerenhout Charles, Luik Peter T, Kerschbaum Julia, Tiefenthaler Martin, Adema Aaltje Y, Stepanov Vadim A, Zulkarnaev Alexey B, Turkmen Kultigin, Fliedner Anselm, Åsberg Anders, Mjoen Geir, Miyasato Hitoshi, de Fijter Carola W H, Mongera Nicola, Pini Stefano, de Biase Consuelo, Duivenvoorden Raphaël, Hilbrands Luuk, Kerckhoffs Angele, Maas Rutger, Lebedeva Olga, Lopez Veronica, Verhave Jacobien, Titov Denis, Parshina Ekaterina V, Zanoli Luca, Marcantoni Carmelita, van Gils-Verrij Liesbeth E A, Harty John C, Meurs Marleen, Myslak Marek, Battaglia Yuri, den Deurwaarder Edwin, Stendahl Maria, Rahimzadeh Hormat, Schouten Marcel, Rychlik Ivan, Cabezas-Reina Carlos J, Roca Ana Maria, Nauta Ferdau, Kanaan Nada, Labriola Laura, Devresse Arnaud, Diaz-Mareque Anabel, Coca Armando, Meijers Björn K I, Naesens Maarten, Kuypers Dirk, Desschans Bruno, Tonnelier Annelies, Wissing Karl M, de Arriba Gabriel, Dedinska Ivana, Pessolano Giuseppina, Gandolfini Ilaria, Maggiore Umberto, Papachristou Evangelos, Franssen Casper F M, Berger Stefan P, Meijer Esther, Özyilmaz Akin, Sanders Jan Stephan F, Ponikvar Jadranka Buturović, Pernat Andreja Marn, Kovac Damjan, Ekart Robert, Abrahams Alferso C, Molenaar Femke M, van Zuilen Arjan D, Meijvis Sabine C A, Dolmans Helma, Tantisattamos Ekamol, Esposito Pasquale, Krzesinski Jean-Marie, Barahira Jean Damacène, Gallieni Maurizio, Sabiu Gianmarco, Martin-Moreno Paloma Leticia, Guglielmetti Gabriele, Guzzo Gabriella, Toapanta Nestor, Luik Antinus J, van Kuijk Willi H M, Stikkelbroeck Lonneke W H, Hermans Marc M H, Rimsevicius Laurynas, Righetti Marco, Islam Mahmud, Braak Nicole Heitink-ter,
Affiliation:
1. Department of Nephrology, Cliniques Universitaires Saint-Luc, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium 2. Department of Nephrology, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France 3. Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 4. Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia 5. Nephrology Clinic, Dialysis and Renal Transplant Center, ‘C.I. PARHON’ University Hospital, ‘Grigore T. Popa’ University of Medicine, Iasi, Romania 6. Nephrology and Dialysis Unit, San Bassiano Hospital, Vicenza, Italy 7. Department of Renal and Transplant, University Hospital of Coventry and Warwickshire and University of Leicester, Coventry, UK 8. Department of Nephrology, Rijnstate Hospital, Arnhem, The Netherlands 9. Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey 10. Department of Nephrology, Medical University of Vienna, Vienna, Austria 11. Department of Medical Informatics, ERA-EDTA Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
Abstract
Abstract
Background
Coronavirus disease 2019 (COVID-19) has exposed haemodialysis (HD) patients and kidney transplant (KT) recipients to an unprecedented life-threatening infectious disease, raising concerns about kidney replacement therapy (KRT) strategy during the pandemic. This study investigated the association of the type of KRT with COVID-19 severity, adjusting for differences in individual characteristics.
Methods
Data on KT recipients and HD patients diagnosed with COVID-19 between 1 February 2020 and 1 December 2020 were retrieved from the European Renal Association COVID-19 Database. Cox regression models adjusted for age, sex, frailty and comorbidities were used to estimate hazard ratios (HRs) for 28-day mortality risk in all patients and in the subsets that were tested because of symptoms.
Results
A total of 1670 patients (496 functional KT and 1174 HD) were included; 16.9% of KT and 23.9% of HD patients died within 28 days of presentation. The unadjusted 28-day mortality risk was 33% lower in KT recipients compared with HD patients {HR 0.67 [95% confidence interval (CI) 0.52–0.85]}. In a fully adjusted model, the risk was 78% higher in KT recipients [HR 1.78 (95% CI 1.22–2.61)] compared with HD patients. This association was similar in patients tested because of symptoms [fully adjusted model HR 2.00 (95% CI 1.31–3.06)]. This risk was dramatically increased during the first post-transplant year. Results were similar for other endpoints (e.g. hospitalization, intensive care unit admission and mortality >28 days) and across subgroups.
Conclusions
KT recipients had a greater risk of a more severe course of COVID-19 compared with HD patients, therefore they require specific infection mitigation strategies.
Funder
ERA-EDTA, the Dutch Kidney Foundation, Baxter and Sandoz
Publisher
Oxford University Press (OUP)
Subject
Transplantation,Nephrology
Cited by
68 articles.
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