COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration
Author:
Hilbrands Luuk B1ORCID, Duivenvoorden Raphaël1, Vart Priya234, Franssen Casper F M4, Hemmelder Marc H5, Jager Kitty J6, Kieneker Lyanne M4, Noordzij Marlies4, Pena Michelle J7, Vries Hanne de4, Arroyo David8, Covic Adrian9, Crespo Marta10, Goffin Eric11, Islam Mahmud12ORCID, Massy Ziad A1314, Montero Nuria15ORCID, Oliveira João P16, Roca Muñoz Ana17, Sanchez J Emilio18, Sridharan Sivakumar19ORCID, Winzeler Rebecca20, Gansevoort Ron T4, van der Net Jeroen B, Essig Marie, du Buf-Vereijken Peggy W G, van Ginneken Betty, Maas Nanda, Vogt Liffert, van Jaarsveld Birgit C, Bemelman Frederike J, Klingenberg-Salahova Farah, Heenan-Vos Frederiek, Vervloet Marc G, Nurmohamed Azam, Abramowicz Daniel, Verhofstede Sabine, Maoujoud Omar, Fialova Jana, Melilli Edoardo, Favà Alex, Cruzado Josep M, Lips Joy, Hengst Maaike, Gellert Ryszard, Rydzewski Andrzej, Alferes Daniela G, Rychlik Ivan, Zakharova Elena V, Ambuehl Patrice Max, Lepeytre Fanny, Rabaté Clémentine, Rostoker Guy, Marques Sofia, Azasevac Tijana, Katicic Dajana, Dam Marc ten, Krüger Thilo, Logtenberg Susan J J, Fricke Lutz, van Zanen A L, Slebe Jeroen J P, Kemlin Delphine, van de Wetering Jacqueline, Eiselt Jaromir, Kielberger Lukas, El-Wakil Hala S, ElHafeez Samar Abd, Canal Christina, Facundo Carme, Ramos Ana M, Debska-Slizien Alicja, Veldhuizen Nicoline M H, Panagoutsos Stylianos, Matceac Irina, Nistor Ionut, Cordos Monica, Groeneveld J H M, van Buren Marjolijn, Diekmann Fritz, Ferreira Ana C, Santos Augusto Cesar S, Arias-Cabrales Carlos, Llinàs-Mallol Laura, Buxeda Anna, Tàrrega Carla Burballa, Redondo-Pachon Dolores, Jimenez Maria Dolores Arenas, Hofstra Julia M, Franco Antonio, Rodríguez-Ferrero María L, Manzanos Sagrario Balda, de Arriba Gabriel, Haridian Sosa Barrios R, Bartelet Karlijn, Demir Erol, Hollander Daan A M J, Kerckhoffs Angele, Büttner Stefan, de Vries Aiko P.J, Meziyerh Soufian, van der Helm Danny, Reinders Marlies, Bouwsma Hanneke, Petruliene Kristina, Maloney Sharon, Verberk Iris, Di Luca Marina, Tuğlular Serhan Z, Beerenhout Charles, Luik Peter T, Kerschbaum Julia, Tiefenthaler Martin, Watschinger Bruno, Adema Aaltje Y, Stepanov Vadim A, Zulkarnaev Alexey B, Turkmen Kultigin, Decenzio Bonucchi, Fliedner Anselm, Miyasato Hitoshi, Åsberg Anders, Mjoen Geir, Pini Stefano, de Biase Consuelo, van de Logt Anne Els, Maas Rutger, Lebedeva Olga, Lopez Veronica, Reichert Louis J M, Verhave Jacobien, Titov Denis, Parshina Ekaterina V, van Gils-Verrij Liesbeth E A, de Bruin Charlotte J R, Harty John C, Meurs Marleen, Myslak Marek, Battaglia Yuri, Lentini Paolo, den Deurwaarder Edwin, Rahimzadeh Hormat, Schouten Marcel, Cabezas-Reina Carlos J, Diaz-Mareque Anabel, Coca Armando, Meijers Björn K I, Naesens Maarten, Kuypers Dirk, Desschans Bruno, Tonnerlier Annelies, Wissing Karl M, Dedinska Ivana, Pessolano Giuseppina, van der Sande Frank M, Christiaans Maarten H L, Gandolfini Ilaria, Maggiore Umberto, Kanaan Nada, Labriola Laura, Devresse Arnaud, Malik Shafi, Berger Stefan P, Meijer Esther, Sanders Jan Stephan F, Ponikvar Jadranka Buturović, Abrahams Alferso C, Molenaar Femke M, van Zuilen Arjan D, Meijvis S C A, Dolmans Helma, Zanoli Luca, Marcantoni Carmelita, Esposito Pasquale, Krzesinski Jean-Marie, Barahira Jean Damacène, Gallieni Maurizio, Martin-Moreno Paloma Leticia, Guglielmetti Gabriele, Guzzo Gabriella, Luik Antinus J, van Kuijk Willi H M, Stikkelbroeck Lonneke W H, Hermans Marc M H, Rimsevicius Laurynas, Righetti Marco, Braak Nicole Heitink-ter,
Affiliation:
1. Department of Nephrology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands 2. Department of Health Evidence, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands 3. Department of Cardiology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands 4. Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 5. Dutch Renal Registry, Nefrovisie foundation, Utrecht, The Netherlands 6. ERA-EDTA Registry, Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands 7. Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, The Netherlands 8. Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain 9. Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania, Dr Ci Parhon Hospital, Iasi, Romania 10. Department of Nephrology, Hospital del Mar, Barcelona, Spain 11. Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium 12. Department of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey 13. Division of Nephrology, Ambroise Paré University Hospital, APHP (Assistance Publique-Hôpitaux de Paris), UVSQ (University Versailles-Saint-Quentin-en-Yvelines) – Paris Saclay, Boulogne Billancourt/Paris, France 14. Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France 15. Department of Nephrology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain 16. Centrodial, São João da Madeira, Portugal 17. Renal Transplant Unit, Toledo University Hospital, Toledo, Spain 18. Department of Nephrology, Hospital Universitario de Cabuenes, Asturias, Spain 19. Department of Renal Unit, Lister Hospital, Stevenage, UK 20. Institute of Nephrology, City Hospital Waid and Triemli, Zürich, Switzerland
Abstract
Abstract
Background. Patients on kidney replacement therapy comprise a vulnerable population and may be at increased risk of death from coronavirus disease 2019 (COVID-19). Currently, only limited data are available on outcomes in this patient population.
Methods. We set up the ERACODA (European Renal Association COVID-19 Database) database, which is specifically designed to prospectively collect detailed data on kidney transplant and dialysis patients with COVID-19. For this analysis, patients were included who presented between 1 February and 1 May 2020 and had complete information available on the primary outcome parameter, 28-day mortality.
Results. Of the 1073 patients enrolled, 305 (28%) were kidney transplant and 768 (72%) dialysis patients with a mean age of 60 ± 13 and 67 ± 14 years, respectively. The 28-day probability of death was 21.3% [95% confidence interval (95% CI) 14.3–30.2%] in kidney transplant and 25.0% (95% CI 20.2–30.0%) in dialysis patients. Mortality was primarily associated with advanced age in kidney transplant patients, and with age and frailty in dialysis patients. After adjusting for sex, age and frailty, in-hospital mortality did not significantly differ between transplant and dialysis patients [hazard ratio (HR) 0.81, 95% CI 0.59–1.10, P = 0.18]. In the subset of dialysis patients who were a candidate for transplantation (n = 148), 8 patients died within 28 days, as compared with 7 deaths in 23 patients who underwent a kidney transplantation <1 year before presentation (HR adjusted for sex, age and frailty 0.20, 95% CI 0.07–0.56, P < 0.01).
Conclusions. The 28-day case-fatality rate is high in patients on kidney replacement therapy with COVID-19 and is primarily driven by the risk factors age and frailty. Furthermore, in the first year after kidney transplantation, patients may be at increased risk of COVID-19-related mortality as compared with dialysis patients on the waiting list for transplantation. This information is important in guiding clinical decision-making, and for informing the public and healthcare authorities on the COVID-19-related mortality risk in kidney transplant and dialysis patients.
Funder
The ERACODA Consortium ERA-EDTA Dutch Kidney Foundation Baxter and Sandoz
Publisher
Oxford University Press (OUP)
Subject
Transplantation,Nephrology
Cited by
347 articles.
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