COVID-19 in patients undergoing chronic kidney replacement therapy and kidney transplant recipients in Scotland: findings and experience from the Scottish renal registry

Abstract

Background: Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland.

Methods: Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed.

Results: During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients.

Conclusion: The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.

Keywords: COVID-19; Epidemiology; Kidney replacement therapy; Registry.

Fig. 1

Dialysis Locations in Scotland (own figure). ARI Aberdeen Royal Infirmary, XH Crosshouse Hospital, DGRI Dumfries and Galloway Royal Infirmary, GLAS Glasgow Royal Infirmary, MONK Monklands Hospital, NINE Ninewells Hospital Dundee, RAIG Raigmore Hospital Inverness, RIE Royal Infirmary of Edinburgh, VHK Victoria Hospital Kirkcaldy

Fig. 2

Geographical output of SARS-CoV-2 in KRT patients up to 31 May 2020 (own figure)

Fig. 3

a: Number of patients* on KRT who tested positive for SARS-CoV-2. *If a patient has been tested multiple times, the date of the first positive or first negative test was used. If a patient has tested positive, then subsequently tested negative they would only appear in the positive cohort. b: Number of patients in Scotland who tested positive for SARS-CoV-2

Fig. 4

a: Cumulative number of SRR patients* on KRT with a SARS-CoV-2 test. b: Cumulative number of SRR patients* on KRT with a SARS-CoV-2 test split by modality. c: Cumulative number of patients in Scotland with a SARS-CoV-2 test (Source: http://www.gov.scot/publications/coronavirus-covid-19-trends-in-daily-data/)

Fig. 5

Number of Deaths in KRT population per calendar month. *For all those patients who tested positive for SARS-CoV-2 – all had SARS-CoV-2 as Cause of Death on death certificate

Fig. 6

Number of deaths in KRT population – comparison over multiple years. *This lines shows the number of deaths after removing those cases where SARS-CoV-2 was the Cause of Death

Fig. 7

a: Survival at 30 days from first SARS-CoV-2 test. *Log Rank Test for KM is p < 0.001. Survival at 30 days: SARS-CoV-2 Neg: 0.91 (95% CI 0.894,0.94); SARS-CoV-2 Positive: 0.71 (95% CI 0.630, 0.802). b: Survival at 30 days from first SARS-CoV-2 Test split by modality at time of test result. Survival at 30 days Haemodialysis: SARS-CoV-2 Neg: 0.92 (95% CI 0.885, 0.94) ; SARS-CoV-2 Positive: 0.71 (95% CI 0.623, 0.817). Survival at 30 days Kidney Transplant: SARS-CoV-2 Neg: 0.94 (95% CI 0.91, 0.98) ; SARS-CoV-2 Positive: 0.71 (95% CI 0.544, 0.915)