tetano
Editor, Senior Moderator
Nephrol Dial Transplant
. 2020 Nov 1;35(11):1973-1983.
doi: 10.1093/ndt/gfaa261.
COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration
Luuk B Hilbrands[SUP] 1 [/SUP], Rapha?l Duivenvoorden[SUP] 1 [/SUP], Priya Vart[SUP] 2 3 4 [/SUP], Casper F M Franssen[SUP] 4 [/SUP], Marc H Hemmelder[SUP] 5 [/SUP], Kitty J Jager[SUP] 6 [/SUP], Lyanne M Kieneker[SUP] 4 [/SUP], Marlies Noordzij[SUP] 4 [/SUP], Michelle J Pena[SUP] 7 [/SUP], Hanne de Vries[SUP] 4 [/SUP], David Arroyo[SUP] 8 [/SUP], Adrian Covic[SUP] 9 [/SUP], Marta Crespo[SUP] 10 [/SUP], Eric Goffin[SUP] 11 [/SUP], Mahmud Islam[SUP] 12 [/SUP], Ziad A Massy[SUP] 13 14 [/SUP], Nuria Montero[SUP] 15 [/SUP], Jo?o P Oliveira[SUP] 16 [/SUP], Ana Roca Mu?oz[SUP] 17 [/SUP], J Emilio Sanchez[SUP] 18 [/SUP], Sivakumar Sridharan[SUP] 19 [/SUP], Rebecca Winzeler[SUP] 20 [/SUP], Ron T Gansevoort[SUP] 4 [/SUP], ERACODA Collaborators
Affiliations
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.
Keywords: COVID-19; dialysis; kidney; mortality; transplantation.
. 2020 Nov 1;35(11):1973-1983.
doi: 10.1093/ndt/gfaa261.
COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration
Luuk B Hilbrands[SUP] 1 [/SUP], Rapha?l Duivenvoorden[SUP] 1 [/SUP], Priya Vart[SUP] 2 3 4 [/SUP], Casper F M Franssen[SUP] 4 [/SUP], Marc H Hemmelder[SUP] 5 [/SUP], Kitty J Jager[SUP] 6 [/SUP], Lyanne M Kieneker[SUP] 4 [/SUP], Marlies Noordzij[SUP] 4 [/SUP], Michelle J Pena[SUP] 7 [/SUP], Hanne de Vries[SUP] 4 [/SUP], David Arroyo[SUP] 8 [/SUP], Adrian Covic[SUP] 9 [/SUP], Marta Crespo[SUP] 10 [/SUP], Eric Goffin[SUP] 11 [/SUP], Mahmud Islam[SUP] 12 [/SUP], Ziad A Massy[SUP] 13 14 [/SUP], Nuria Montero[SUP] 15 [/SUP], Jo?o P Oliveira[SUP] 16 [/SUP], Ana Roca Mu?oz[SUP] 17 [/SUP], J Emilio Sanchez[SUP] 18 [/SUP], Sivakumar Sridharan[SUP] 19 [/SUP], Rebecca Winzeler[SUP] 20 [/SUP], Ron T Gansevoort[SUP] 4 [/SUP], ERACODA Collaborators
Affiliations
- PMID: 33151337
- DOI: 10.1093/ndt/gfaa261
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.
Keywords: COVID-19; dialysis; kidney; mortality; transplantation.