COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration
Luuk B. Hilbrands, Raphaël Duivenvoorden, Priya Vart, Casper Franssen, Marc H. Hemmelder, Kitty J. Jager, Lyanne M. Kieneker, Marlies Noordzij, Michelle J. Pena, Hanne de Vries, David Arroyo, Adrian Covic, Marta Crespo, Éric Goffin, Mahmud İslam, Ziad A. Massy, Núria Montero, João Oliveira, Ana Roca Muñoz, J. Emilio Sánchez-Álvarez, Sivakumar Sridharan, Rebecca Winzeler, Ron T. Gansevoort, ERACODA Collaborators, Jeroen B. van der Net, Marie Essig, Peggy W G du Buf-Vereijken, Betty van Ginneken, Nanda Maas, 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, Jana Fialová, Edoardo Melilli, Àlex Favà, Josep M. Cruzado, Joy Lips, Maaike Hengst, Ryszard Gellert, Andrzej Rydzewski, Daniela G Alferes, Ivan Rychlík, Elena Zakharova, Patrice Max Ambuehl, Fanny Lepeytre, Clémentine Rabaté, Guy Rostoker, Sofia Marques, Tijana Azaševac, Dajana Katičić, Marc ten Dam, Thilo Krüger, S. J. J. Logtenberg, Lutz Fricke, Adriaan L Zanen, Jeroen J P Slebe, Delphine Kemlin, Jacqueline van de Wetering, Jaromír Eiselt, Lukáš Kielberger, Hala S El-Wakil, Samar Abd ElHafeez, C Canal, Carme Facundo, Ana Ramos, Alicja Dębska‐Ślizień, Nicoline M H Veldhuizen, Stylianos Panagoutsos, Irina Matceac, Ionuţ Nistor, Monica Cordos, J H M Groeneveld, Marjolijn van Buren, Fritz Diekmann, Ana Cristina Fernandes Maria Ferreira, Augusto César Soares dos Santos, Carlos Arias-Cabrales, Laura Llinàs-Mallol, Anna Buxeda, Carla Burballa Tàrrega, Dolores Redondo‐Pachón, María Dolores Arenas Jiménez, Julia M. Hofstra, Antonio Franco, María Luisa Rodríguez, Sagrario Balda Manzanos, Gabriel de Arriba, R. Haridian Sosa Barrios, Karlijn Bartelet, Erol Demir, Daan A M J Hollander, Angèle P. M. Kerckhoffs, Stefan Büttner
Abstract
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.