COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration

Luuk B Hilbrands, Raphaël Duivenvoorden, Priya Vart, Casper F M Franssen, Marc H Hemmelder, Kitty J Jager, Lyanne M Kieneker, Marlies Noordzij, Michelle J Pena, Hanne de Vries, David Arroyo, Adrian Covic, Marta Crespo, Eric Goffin, Mahmud Islam, Ziad A Massy, Nuria Montero, João P Oliveira, Ana Roca Muñoz, J Emilio Sanchez, 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, Birgit C. van Jaarsveld, Frederike J. Bemelman, Farah Klingenberg-Salahova, Frederiek Heenan-Vos, Marc G. Vervloet, Azam Nurmohamed, Daniel Abramowicz, Sabine Verhofstede, Omar Maoujoud, Jana Fialova, Edoardo Melilli, Alex Favà, Josep M. Cruzado, Joy Lips, Maaike Hengst, Ryszard Gellert, Andrzej Rydzewski, Daniela G. Alferes, Ivan Rychlik, Elena V. Zakharova, Patrice Max Ambuehl, Fanny Lepeytre, Clémentine Rabaté, Guy Rostoker, Sofia Marques, Tijana Azasevac, Dajana Katicic, Marc ten Dam, Thilo Krüger, Susan J J Logtenberg, Lutz Fricke, A L van Zanen, Jeroen J P Slebe, Delphine Kemlin, Jacqueline van de Wetering, Jaromir Eiselt, Lukas Kielberger, Hala S. El-Wakil, Samar Abd ElHafeez, Christina Canal, Carme Facundo, Ana M. Ramos, Alicja Debska-Slizien, Nicoline M H Veldhuizen, Stylianos Panagoutsos, Irina Matceac, Ionut Nistor, Monica Cordos, J H M Groeneveld, Marjolijn van Buren, Fritz Diekmann, Ana C. Ferreira, Augusto Cesar S. Santos Jr., Carlos Arias-Cabrales, Laura Llinàs-Mallol, Anna Buxeda, Carla Burballa Tàrrega, Dolores Redondo-Pachon, Maria Dolores Arenas Jimenez, Julia M. Hofstra, Antonio Franco, María L. Rodríguez-Ferrero, Sagrario Balda Manzanos, Gabriel de Arriba, R. Haridian Sosa Barrios, Karlijn Bartelet, Erol Demir, Daan A M J Hollander, Angele Kerckhoffs, Stefan Büttner, Aiko P J de Vries, Soufian Meziyerh, Danny van der Helm, Marlies Reinders, Hanneke Bouwsma, Kristina Petruliene, Sharon Maloney, Iris Verberk, Marina Di Luca, Serhan Z. Tuğlular, Charles Beerenhout, Peter T. Luik, Julia Kerschbaum, Martin Tiefenthaler, Bruno Watschinger, Aaltje Y. Adema, Vadim A. Stepanov, Alexey B. Zulkarnaev, Kultigin Turkmen, Bonucchi Decenzio, Anselm Fliedner, Hitoshi Miyasato, Anders Åsberg, Geir Mjoen, Stefano Pini, Consuelo de Biase, Anne Els van de Logt, Rutger Maas, Olga Lebedeva, Veronica Lopez, Louis J M Reichert, Jacobien Verhave, Denis Titov, Ekaterina V. Parshina, Liesbeth E A van Gils-Verrij, Charlotte J R de Bruin, John C. Harty, Marleen Meurs, Marek Myslak, Yuri Battaglia, Paolo Lentini, Edwin den Deurwaarder, Hormat Rahimzadeh, Marcel Schouten, Carlos J. Cabezas-Reina, Anabel Diaz-Mareque, Armando Coca, Björn K I Meijers, Maarten Naesens, Dirk Kuypers, Bruno Desschans, Annelies Tonnerlier, Karl M. Wissing, Ivana Dedinska, Giuseppina Pessolano, Frank M. van der Sande, Maarten H L Christiaans, Ilaria Gandolfini, Umberto Maggiore, Nada Kanaan, Laura Labriola, Arnaud Devresse, Shafi Malik, Stefan P. Berger, Esther Meijer, Jan Stephan F. Sanders, Jadranka Buturović Ponikvar, Alferso C. Abrahams, Femke M. Molenaar, Arjan D. van Zuilen, S C A Meijvis, Helma Dolmans, Luca Zanoli, Carmelita Marcantoni, Pasquale Esposito, Jean-Marie Krzesinski, Jean Damacène Barahira, Maurizio Gallieni, Gianmarco Sabiu, Paloma Leticia Martin-Moreno, Gabriele Guglielmetti, Gabriella Guzzo, Antinus J. Luik, Willi H M van Kuijk, Lonneke W H Stikkelbroeck, Marc M.H. Hermans, Laurynas Rimsevicius, Marco Righetti, Nicole Heitink-ter Braak, Luuk B Hilbrands, Raphaël Duivenvoorden, Priya Vart, Casper F M Franssen, Marc H Hemmelder, Kitty J Jager, Lyanne M Kieneker, Marlies Noordzij, Michelle J Pena, Hanne de Vries, David Arroyo, Adrian Covic, Marta Crespo, Eric Goffin, Mahmud Islam, Ziad A Massy, Nuria Montero, João P Oliveira, Ana Roca Muñoz, J Emilio Sanchez, 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, Birgit C. van Jaarsveld, Frederike J. Bemelman, Farah Klingenberg-Salahova, Frederiek Heenan-Vos, Marc G. Vervloet, Azam Nurmohamed, Daniel Abramowicz, Sabine Verhofstede, Omar Maoujoud, Jana Fialova, Edoardo Melilli, Alex Favà, Josep M. Cruzado, Joy Lips, Maaike Hengst, Ryszard Gellert, Andrzej Rydzewski, Daniela G. Alferes, Ivan Rychlik, Elena V. Zakharova, Patrice Max Ambuehl, Fanny Lepeytre, Clémentine Rabaté, Guy Rostoker, Sofia Marques, Tijana Azasevac, Dajana Katicic, Marc ten Dam, Thilo Krüger, Susan J J Logtenberg, Lutz Fricke, A L van Zanen, Jeroen J P Slebe, Delphine Kemlin, Jacqueline van de Wetering, Jaromir Eiselt, Lukas Kielberger, Hala S. El-Wakil, Samar Abd ElHafeez, Christina Canal, Carme Facundo, Ana M. Ramos, Alicja Debska-Slizien, Nicoline M H Veldhuizen, Stylianos Panagoutsos, Irina Matceac, Ionut Nistor, Monica Cordos, J H M Groeneveld, Marjolijn van Buren, Fritz Diekmann, Ana C. Ferreira, Augusto Cesar S. Santos Jr., Carlos Arias-Cabrales, Laura Llinàs-Mallol, Anna Buxeda, Carla Burballa Tàrrega, Dolores Redondo-Pachon, Maria Dolores Arenas Jimenez, Julia M. Hofstra, Antonio Franco, María L. Rodríguez-Ferrero, Sagrario Balda Manzanos, Gabriel de Arriba, R. Haridian Sosa Barrios, Karlijn Bartelet, Erol Demir, Daan A M J Hollander, Angele Kerckhoffs, Stefan Büttner, Aiko P J de Vries, Soufian Meziyerh, Danny van der Helm, Marlies Reinders, Hanneke Bouwsma, Kristina Petruliene, Sharon Maloney, Iris Verberk, Marina Di Luca, Serhan Z. Tuğlular, Charles Beerenhout, Peter T. Luik, Julia Kerschbaum, Martin Tiefenthaler, Bruno Watschinger, Aaltje Y. Adema, Vadim A. Stepanov, Alexey B. Zulkarnaev, Kultigin Turkmen, Bonucchi Decenzio, Anselm Fliedner, Hitoshi Miyasato, Anders Åsberg, Geir Mjoen, Stefano Pini, Consuelo de Biase, Anne Els van de Logt, Rutger Maas, Olga Lebedeva, Veronica Lopez, Louis J M Reichert, Jacobien Verhave, Denis Titov, Ekaterina V. Parshina, Liesbeth E A van Gils-Verrij, Charlotte J R de Bruin, John C. Harty, Marleen Meurs, Marek Myslak, Yuri Battaglia, Paolo Lentini, Edwin den Deurwaarder, Hormat Rahimzadeh, Marcel Schouten, Carlos J. Cabezas-Reina, Anabel Diaz-Mareque, Armando Coca, Björn K I Meijers, Maarten Naesens, Dirk Kuypers, Bruno Desschans, Annelies Tonnerlier, Karl M. Wissing, Ivana Dedinska, Giuseppina Pessolano, Frank M. van der Sande, Maarten H L Christiaans, Ilaria Gandolfini, Umberto Maggiore, Nada Kanaan, Laura Labriola, Arnaud Devresse, Shafi Malik, Stefan P. Berger, Esther Meijer, Jan Stephan F. Sanders, Jadranka Buturović Ponikvar, Alferso C. Abrahams, Femke M. Molenaar, Arjan D. van Zuilen, S C A Meijvis, Helma Dolmans, Luca Zanoli, Carmelita Marcantoni, Pasquale Esposito, Jean-Marie Krzesinski, Jean Damacène Barahira, Maurizio Gallieni, Gianmarco Sabiu, Paloma Leticia Martin-Moreno, Gabriele Guglielmetti, Gabriella Guzzo, Antinus J. Luik, Willi H M van Kuijk, Lonneke W H Stikkelbroeck, Marc M.H. Hermans, Laurynas Rimsevicius, Marco Righetti, Nicole Heitink-ter Braak

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.

© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Figures

FIGURE 1
FIGURE 1
Vital status at Day 28 after presentation with COVID-19 of (A) kidney transplant (n = 305) and (B) haemodialysis patients (n = 768).
FIGURE 2
FIGURE 2
Relationship between age, clinical frailty score and 28-day case-fatality rate in (A) kidney transplant and (B) dialysis patients with COVID-19. Age and clinical frailty scores are subdivided into three clinical classes.
FIGURE 3
FIGURE 3
Association of demographic factors, major cardiovascular disease risk factors and chronic lung disease with 28-day mortality in dialysis and kidney transplant patients with COVID-19. Results are shown for a full adjusted multivariate model that includes the covariates shown in the graphs to allow comparison with data from the literature. Panel (A) shows results for patients on dialysis. Panel (B) shows results for patients living with a kidney transplant.

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