COVID-19-related mortality in kidney transplant and haemodialysis patients: A comparative, prospective registry-based study

Goffin, E.; Candellier, A.; Vart, P.; Noordzij, M.; Arnol, M.; Covic, A.; Lentini, P.; Malik, S.; Reichert, L. J.; Sever, M. S.; Watschinger, B.; Jager, K. J.; Gansevoort, R. T.; Van Der Net, J. B.; Essig, M.; Du Buf-Vereijken, P. W. G.; Van Ginneken, B.; Vogt, L.; Van Jaarsveld, B. C.; Bemelman, F. J.; Klingenberg-Salahova, F.; Heenan-Vos, F.; Vervloet, M. G.; Nurmohamed, A.; Abramowicz, D.; Verhofstede, S.; Maoujoud, O.; Malfait, T.; Avitum, B. B.; Fialova, J.; Melilli, E.; Fava, A.; Cruzado, J. M.; Perez, N. M.; Lips, J.; Krepel, H.; Adilovic, H.; Hengst, M.; Rydzewski, A.; Gellert, R.; Oliveira, J.; Alferes, D. G.; Zakharova, E. V.; Ambuehl, P. M.; Walker, A.; Winzeler, R.; Lepeytre, F.; Rabate, C.; Rostoker, G.; Marques, S.; Azasevac, T.; Katicic, D.; Ten Dam, M.; Kruger, T.; Brzosko, S.; Zanen, A. L.; Logtenberg, S. J. J.; Fricke, L.; Slebe, J. J. P.; Kemlin, D.; Van De Wetering, J.; Reinders, M. E. J.; Eiselt, J.; Kielberger, L.; El-Wakil, H. S.; Verhoeven, M. A. M.; Canal, C.; Facundo, C.; Ramos, A. M.; Debska-Slizien, A.; Veldhuizen, N. M. H.; Tigka, E.; Konsta, M. A. P.; Panagoutsos, S.; Mallamaci, F.; Matceac, I.; Nistor, I.; Cordos, M.; Groeneveld, J. H. M.; Jousma, J.; Van Buren, M.; Elhafeez, S. A.; Diekmann, F.; Pereira, T. A.; Santos, A. C. S.; Arias-Cabrales, C.; Crespo, M.; Llinas-Mallol, L.; Buxeda, A.; Tarrega, C. B.; Redondo-Pachon, D.; Jimenez, M. D. A.; Hofstra, J. M.; Franco, A.; Arroyo, D.; Rodriguez-Ferrero, M. L.; Manzanos, S. B.; Barrios, R. H. S.; Avila, G.; Laranjinha, I.; Mateus, C.; Lemahieu, W.; Dirim, A. B.; Demir, E.; A Afak, S.; Turkmen, A.; Hollander, D. A. M. J.; Buttner, S.; De Vries, A. P. J.; Meziyerh, S.; Van Der Helm, D.; Mallat, M.; Bouwsma, H.; Sridharan, S.; Petruliene, K.; Maloney, S. -R.; Verberk, I.; Van Der Sande, F. M.; Christiaans, M. H. L.; Hemmelder, M.; Kumar, M. N.; Di Luca, M.; Tuglular, S. Z.; Kramer, A.; Beerenhout, C.; Luik, P. T.; Kerschbaum, J.; Tiefenthaler, M.; Adema, A. Y.; Stepanov, V. A.; Zulkarnaev, A. B.; Turkmen, K.; Fliedner, A.; Asberg, A.; Mjoen, G.; Miyasato, H.; De Fijter, C. W. H.; Mongera, N.; Pini, S.; De Biase, C.; Duivenvoorden, R.; Hilbrands, L.; Kerckhoffs, A.; Maas, R.; Lebedeva, O.; Lopez, V.; Verhave, J.; Titov, D.; Parshina, E. V.; Zanoli, L.; Marcantoni, C.; Van Gils-Verrij, L. E. A.; Harty, J. C.; Meurs, M.; Myslak, M.; Battaglia, Y.; Den Deurwaarder, E.; Stendahl, M.; Rahimzadeh, H.; Schouten, M.; Rychlik, I.; Cabezas-Reina, C. J.; Roca, A. M.; Nauta, F.; Kanaan, N.; Labriola, L.; Devresse, A.; Diaz-Mareque, A.; Coca, A.; Meijers, B. K. I.; Naesens, M.; Kuypers, D.; Desschans, B.; Tonnelier, A.; Wissing, K. M.; De Arriba, G.; Dedinska, I.; Pessolano, G.; Gandolfini, I.; Maggiore, U.; Papachristou, E.; Franssen, C. F. M.; Berger, S. P.; Meijer, E.; Ozyilmaz, A.; Sanders, J. S. F.; Ponikvar, J. B.; Pernat, A. M.; Kovac, D.; Ekart, R.; Abrahams, A. C.; Molenaar, F. M.; Van Zuilen, A. D.; Meijvis, S. C. A.; Dolmans, H.; Tantisattamos, E.; Esposito, P.; Krzesinski, J. -M.; Barahira, J. D.; Gallieni, M.; Sabiu, G.; Martin-Moreno, P. L.; Guglielmetti, G.; Guzzo, G.; Toapanta, N.; Luik, A. J.; Van Kuijk, W. H. M.; Stikkelbroeck, L. W. H.; Hermans, M. M. H.; Rimsevicius, L.; Righetti, M.; Islam, M.; Braak, N. H. -T.

doi:10.1093/ndt/gfab200

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.