Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe

Kitty J Jager, Anneke Kramer, Nicholas C Chesnaye, Cécile Couchoud, J Emilio Sánchez-Álvarez, Liliana Garneata, Fréderic Collart, Marc H Hemmelder, Patrice Ambühl, Julia Kerschbaum, Camille Legeai, María Dolores Del Pino Y Pino, Gabriel Mircescu, Lionel Mazzoleni, Tiny Hoekstra, Rebecca Winzeler, Gert Mayer, Vianda S Stel, Christoph Wanner, Carmine Zoccali, Ziad A Massy, Kitty J Jager, Anneke Kramer, Nicholas C Chesnaye, Cécile Couchoud, J Emilio Sánchez-Álvarez, Liliana Garneata, Fréderic Collart, Marc H Hemmelder, Patrice Ambühl, Julia Kerschbaum, Camille Legeai, María Dolores Del Pino Y Pino, Gabriel Mircescu, Lionel Mazzoleni, Tiny Hoekstra, Rebecca Winzeler, Gert Mayer, Vianda S Stel, Christoph Wanner, Carmine Zoccali, Ziad A Massy

Abstract

The aim of this study was to investigate 28-day mortality after COVID-19 diagnosis in the European kidney replacement therapy population. In addition, we determined the role of patient characteristics, treatment factors, and country on mortality risk with the use of ERA-EDTA Registry data on patients receiving kidney replacement therapy in Europe from February 1, 2020, to April 30, 2020. Additional data on all patients with a diagnosis of COVID-19 were collected from 7 European countries encompassing 4298 patients. COVID-19-attributable mortality was calculated using propensity score-matched historic control data and after 28 days of follow-up was 20.0% (95% confidence interval 18.7%-21.4%) in 3285 patients receiving dialysis and 19.9% (17.5%-22.5%) in 1013 recipients of a transplant. We identified differences in COVID-19 mortality across countries, and an increased mortality risk in older patients receiving kidney replacement therapy and male patients receiving dialysis. In recipients of kidney transplants ≥75 years of age, 44.3% (35.7%-53.9%) did not survive COVID-19. Mortality risk was 1.28 (1.02-1.60) times higher in transplant recipients compared with matched dialysis patients. Thus, the pandemic has had a substantial effect on mortality in patients receiving kidney replacement therapy, a highly vulnerable population due to underlying chronic kidney disease and a high prevalence of multimorbidity.

Keywords: COVID-19; attributable mortality; dialysis; kidney replacement therapy; registries; transplantation.

Copyright © 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Probability of death among dialysis patients (left panel) and transplant patients (right panel) with coronavirus disease 2019 (COVID-19) and a propensity score–matched control group without COVID-19 (alive at, and followed from, March 15, 2017). CI, confidence interval.
Figure 2
Figure 2
Probability of death 28 days after diagnosis of coronavirus disease 2019 and number at risk for dialysis patients (top) and transplant patients (bottom), by age at diagnosis. Axis scales differ for dialysis and transplant graphs. Two transplant patients >90 years of age at diagnosis were included in the 80+ age group.
Figure 3
Figure 3
Probability of death among dialysis patients (left) and transplant patients (right) with coronavirus disease 2019 (COVID-19), by country. CI, confidence interval.

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Source: PubMed

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