TY - JOUR
T1 - COVID-19-related mortality in kidney transplant and dialysis patients
T2 - results of the ERACODA collaboration
AU - ERACODA Collaborators
AU - Hilbrands, Luuk B
AU - Duivenvoorden, Raphaël
AU - Vart, Priya
AU - Franssen, Casper F M
AU - Hemmelder, Marc H
AU - Jager, Kitty J
AU - Kieneker, Lyanne M
AU - Noordzij, Marlies
AU - Pena, Michelle J
AU - Vries, Hanne de
AU - Arroyo, David
AU - Covic, Adrian
AU - Crespo, Marta
AU - Goffin, Eric
AU - Islam, Mahmud
AU - Massy, Ziad A
AU - Montero, Nuria
AU - Oliveira, João P
AU - Roca Muñoz, Ana
AU - Sanchez, J Emilio
AU - Sridharan, Sivakumar
AU - Winzeler, Rebecca
AU - Gansevoort, Ron T
AU - Wissing, Karl Martin
N1 - © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - 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.
AB - 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.
KW - Adult
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - COVID-19/chemically induced
KW - Databases, Factual
KW - Europe/epidemiology
KW - Female
KW - Humans
KW - Kidney Failure, Chronic/mortality
KW - Kidney Transplantation/mortality
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Prospective Studies
KW - Renal Dialysis/mortality
KW - Risk Factors
KW - SARS-CoV-2/isolation & purification
KW - Survival Rate
KW - Waiting Lists/mortality
UR - http://www.scopus.com/inward/record.url?scp=85095861968&partnerID=8YFLogxK
U2 - 10.1093/ndt/gfaa261
DO - 10.1093/ndt/gfaa261
M3 - Article
C2 - 33151337
VL - 35
SP - 1973
EP - 1983
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
SN - 0931-0509
IS - 11
ER -