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. 2021 Nov 9;36(11):2094-2105.
doi: 10.1093/ndt/gfab200.

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

Eric Goffin  1 , Alexandre Candellier  1   2 , Priya Vart  3 , Marlies Noordzij  3 , Miha Arnol  4 , Adrian Covic  5 , Paolo Lentini  6 , Shafi Malik  7 , Louis J Reichert  8 , Mehmet S Sever  9 , Bruno Watschinger  10 , Kitty J Jager  11 , Ron T Gansevoort  3 ; ERACODA Collaborators
Collaborators, Affiliations

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

Eric Goffin et al. Nephrol Dial Transplant. .

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.

Keywords: COVID-19; dialysis; kidney; mortality; transplantation.

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Figures

FIGURE 1
FIGURE 1
Forest plot showing HRs for association of type of KRT (KT versus HD) with 28-day mortality in the total study population and in the subgroup of those patients tested for COVID-19 based on symptoms only. Model 1: crude; Model 2: age, sex; Model 3: Model 2 + frailty; Model 4: Model 3 + obesity, hypertension, diabetes, heart failure, chronic lung disease and smoking; Model 5: Model 4 + duration of kidney failure and kidney function.
See this image and copyright information in PMC

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