COVID-19-related mortality in kidney transplant and haemodialysis patients: a comparative, prospective registry-based study
Éric Goffin, Alexandre Candellier, Priya Vart, Marlies Noordzij, Miha Arnol, Adrian Covic, Paolo Lentini, Shafi Malik, Louis Reichert, Mehmet Şükrü Sever, Bruno Watschinger, Kitty J. Jager, Ron T. Gansevoort, ERACODA Collaborators, Jeroen B. van der Net, Marie Essig, Peggy W G du Buf-Vereijken, Betty van Ginneken, Liffert Vogt, Brigit C. van Jaarsveld, Fréderike J. Bemelman, Farah Klingenberg-Salahova, Frederiek Heenan‐Vos, Marc Vervloet, Azam Nurmohamed, Daniel Abramowicz, Sabine Verhofstede, Omar Maoujoud, Thomas Malfait, B Braun Avitum, Jana Fialová, Edoardo Melilli, Alexandre Favà, Josep M. Cruzado, Núria Montero Pérez, Joy Lips, Harmen Krepel, Harun Adilović, Maaike Hengst, Andrzej Rydzewski, Ryszard Gellert, João Oliveira, Daniela G Alferes, Elena Zakharova, Patrice Max Ambuehl, Andrea Walker, Rebecca Winzeler, Fanny Lepeytre, Clémentine Rabaté, Guy Rostoker, Sofia Marques, Tijana Azaševac, Dajana Katičić, Marc ten Dam, Thilo Krüger, Szymon Brzosko, Adriaan L Zanen, S. J. J. Logtenberg, Lutz Fricke, Jeroen J P Slebe, Delphine Kemlin, Jacqueline van de Wetering, Marlies E. J. Reinders, Jaromír Eiselt, Lukáš Kielberger, Hala S El-Wakil, Martine A M Verhoeven, Cristina Canal, Carme Facundo, Ana Ramos, Alicja Dębska‐Ślizień, Nicoline M H Veldhuizen, Eirini Tigka, Maria Konsta, Stylianos Panagoutsos, Francesca Mallamaci, Irina Matceac, Ionuţ Nistor, Monica Cordos, J H M Groeneveld, Jolanda Jousma, Marjolijn van Buren, Samar Abd ElHafeez, Fritz Diekmann, Tiago Assis Pereira, Augusto César Soares dos Santos, Carlos Arias-Cabrales, Marta Crespo, Laura Llinàs-Mallol, Anna Buxeda, Carla Burballa Tàrrega, Dolores Redondo‐Pachón, María Dolores Arenas Jiménez, Julia M. Hofstra, Antonio Franco, David Arroyo, María Luisa Rodríguez, Sagrario Balda Manzanos, R. Haridian Sosa Barrios, Gonçalo Ávila
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.