COVID-19-related mortality in kidney transplant and haemodialysis patients: a comparative, prospective registry-based study
Por:
Goffin, E, Candellier, A, Vart, P, Noordzij, M, Arnol, M, Covic, A, Lentini, P, Malik, S, Reichert, LJ, Sever, MS, Watschinger, B, Jager, KJ, Gansevoort, RT, Canal C., Facundo C., ERACODA Collaborators
Publicada:
1 nov 2021
Ahead of Print:
1 jun 2021
Resumen:
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.
Filiaciones:
Goffin, E:
Catholic Univ Louvain, Inst Expt & Clin Res, Dept Nephrol, Clin Univ St Luc, Brussels, Belgium
Candellier, A:
Catholic Univ Louvain, Inst Expt & Clin Res, Dept Nephrol, Clin Univ St Luc, Brussels, Belgium
Ctr Hosp Univ Amiens Picardie, Dept Nephrol, Amiens, France
Vart, P:
Univ Groningen, Univ Med Ctr Groningen, Dept Internal Med, Groningen, Netherlands
Noordzij, M:
Univ Groningen, Univ Med Ctr Groningen, Dept Internal Med, Groningen, Netherlands
Arnol, M:
Univ Med Ctr Ljubljana, Dept Nephrol, Ljubljana, Slovenia
Covic, A:
Grigore T PopaUniv Med, CI PARHON Univ Hosp, Nephrol Clin Dialysis & Renal Transplant Ctr, Iasi, Romania
Lentini, P:
San Bassiano Hosp, Nephrol & Dialysis Unit, Vicenza, Italy
Malik, S:
Univ Hosp Coventry & Warwickshire, Dept Renal & Transplant, Coventry, W Midlands, England
Univ Leicester, Coventry, W Midlands, England
Reichert, LJ:
Rijnstate Hosp, Dept Nephrol, Arnhem, Netherlands
Sever, MS:
Istanbul Univ, Istanbul Sch Med, Dept Nephrol, Istanbul, Turkey
Watschinger, B:
Med Univ Vienna, Dept Nephrol, Vienna, Austria
Jager, KJ:
Univ Amsterdam, Amsterdam Univ Med Ctr, Amsterdam Publ Hlth Res Inst, Dept Med Informat,ERA EDTA Registry, Amsterdam, Netherlands
Gansevoort, RT:
Univ Groningen, Univ Med Ctr Groningen, Dept Internal Med, Groningen, Netherlands
Canal C.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Facundo C.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Green Published, hybrid
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