COVID-19-related mortality in kidney transplant and haemodialysis patients: A comparative, prospective registry-based study

Eric Goffin, Alexandre Candellier, ERACODA Collaborators, Priya Vart, Marlies Noordzij, Miha Arnol, Adrian Covic, Paolo Lentini, Shafi Malik, Louis J. Reichert, Mehmet S. Sever, Bruno Watschinger, Kitty J. Jager, Ron T. Gansevoort*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

42 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)2094-2105
Number of pages12
JournalNephrology Dialysis Transplantation
Volume36
Issue number11
Early online date16 Jun 2021
DOIs
Publication statusPublished - Nov 2021

Bibliographical note

FUNDING:
ERACODA received unrestricted research grants from the
ERA-EDTA, the Dutch Kidney Foundation, Baxter and
Sandoz.

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.

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