TY - JOUR
T1 - COVID-19-related mortality in kidney transplant and haemodialysis patients
T2 - A comparative, prospective registry-based study
AU - Goffin, Eric
AU - Candellier, Alexandre
AU - Vart, Priya
AU - Noordzij, Marlies
AU - Arnol, Miha
AU - Covic, Adrian
AU - Lentini, Paolo
AU - Malik, Shafi
AU - Reichert, Louis J.
AU - Sever, Mehmet S.
AU - Watschinger, Bruno
AU - Jager, Kitty J.
AU - Gansevoort, Ron T.
AU - ERACODA Collaborators
AU - van der Net, Jeroen B.
AU - Essig, Marie
AU - du Buf-Vereijken, Peggy W. G.
AU - van Ginneken, Betty
AU - Vogt, Liffert
AU - van Jaarsveld, Brigit C.
AU - Bemelman, Frederike J.
AU - Klingenberg-Salahova, Farah
AU - Heenan-Vos, Frederiek
AU - Vervloet, Marc G.
AU - Nurmohamed, Azam
AU - Abramowicz, Daniel
AU - Verhofstede, Sabine
AU - Maoujoud, Omar
AU - Malfait, Thomas
AU - Avitum, B. Braun
AU - Fialova, Jana
AU - Melilli, Edoardo
AU - Favà, Alexandre
AU - Cruzado, Josep M.
AU - Perez, Nuria Montero
AU - Lips, Joy
AU - Krepel, Harmen
AU - Adilovic, Harun
AU - Hengst, Maaike
AU - Rydzewski, Andrzej
AU - Gellert, Ryszard
AU - Oliveira, João
AU - Alferes, Daniela G.
AU - Zakharova, Elena V.
AU - Ambuehl, Patrice Max
AU - Walker, Andrea
AU - Winzeler, Rebecca
AU - Lepeytre, Fanny
AU - Rabaté, Clémentine
AU - Duivenvoorden, Raphaël
AU - Schouten, Marcel
AU - Adema, Aaltje Y.
AU - Meurs, Marleen
AU - Sanders, Jan Stephan F.
N1 - Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - Humans
KW - Kidney Failure, Chronic/therapy
KW - Kidney Transplantation/adverse effects
KW - Registries
KW - Renal Dialysis
KW - Risk Factors
KW - SARS-CoV-2
KW - Transplant Recipients
KW - dialysis
KW - kidney
KW - mortality
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=85115119903&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85115119903&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/34132811
U2 - https://doi.org/10.1093/ndt/gfab200
DO - https://doi.org/10.1093/ndt/gfab200
M3 - Article
C2 - 34132811
SN - 0931-0509
VL - 36
SP - 2094
EP - 2105
JO - Nephrology, dialysis, transplantation
JF - Nephrology, dialysis, transplantation
IS - 11
ER -