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

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 6 13 and 67 6 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 ¼ 0.18]. In the subset of dialysis patients who were a candidate for transplantation (n ¼ 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. © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Authors
Hilbrands L.B.1 , Duivenvoorden R.1 , Vart P.2, 3, 4 , Franssen C.F.M.4 , Hemmelder M.H.5 , Jager K.J.6 , Kieneker L.M.4 , Noordzij M.4 , Pena M.J.7 , De Vries H. , Arroyo D.8 , Covic A.9, 10 , Crespo M.11 , Goffin E.12 , Islam M.13 , Massy Z.A.14, 15 , Montero N.16 , Oliveira J.P.17 , Muñoz A.R.18 , Sanchez J.E.19 , Sridharan S.20 , Winzeler R.21 , Gansevoort R.T.4 , Van Der Net J.B. , Essig M.23 , Du Buf-Vereijken P.W.G. , Van Ginneken B. , Maas N.24 , Vogt L.25 , Van Jaarsveld B.C. , Bemelman F.J.25 , Klingenberg-Salahova F.25 , Heenan-Vos F.25 , Vervloet M.G.25 , Nurmohamed A.25 , Abramowicz D.26 , Verhofstede S.26 , Maoujoud O.27 , Fialova J.28 , Melilli E.29 , Favà A.29 , Cruzado J.M.29 , Lips J.30 , Hengst M.31 , Gellert R.32 , Rydzewski A.33 , Alferes D.G.34 , Rychlik I.35 , Zakharova E.V. 36 , Ambuehl P.M.37 , Lepeytre F.38 , Rabaté C.38 , Rostoker G.38 , Marques S.39 , Azasevac T.40 , Katicic D.41 , Ten Dam M. , Krüger T.43 , Logtenberg S.J.J.44 , Fricke L.45 , Van Zanen A.L. , Slebe J.J.P.47 , Kemlin D.48 , Van De Wetering J. , Eiselt J.50 , Kielberger L.50 , El-Wakil H.S.51 , ElHafeez S.A.52 , Canal C.53 , Facundo C.53 , Ramos A.M.53 , Debska-Slizien A.54 , Veldhuizen N.M.H.55 , Panagoutsos S.56 , Matceac I.9, 10 , Nistor I.9, 10 , Cordos M.9, 10 , Groeneveld J.H.M.57 , Van Buren M. , Diekmann F.59 , Ferreira A.C.60 , Santos A.C.S.Jr. , Arias-Cabrales C.62 , Llinàs-Mallol L.62 , Buxeda A.62 , Tàrrega C.B.62 , Redondo-Pachon D.62 , Jimenez M.D.A.62 , Hofstra J.M.63 , Franco A.64 , Rodríguez-Ferrero M.L.65 , Manzanos S.B.66 , De Arriba G. , Barrios R.H.S.68 , Bartelet K.69 , Demir E.70 , Hollander D.A.M.J.71 , Kerckhoffs A.71 , Büttner S.72 , De Vries A.P.J. , Meziyerh S.73 , Van Der Helm D. , Reinders M.73 , Bouwsma H.73 , Petruliene K.74 , Maloney S.75 , Verberk I.76 , Di Luca M. , Tuglular S.Z.78 , Beerenhout C.79 , Luik P.T.80 , Kerschbaum J.81 , Tiefenthaler M.81 , Watschinger B.82 , Adema A.Y.83 , Stepanov V.A.84 , Zulkarnaev A.B.84 , Turkmen K.85 , Decenzio B.86 , Fliedner A.87 , Miyasato H.88 , Åsberg A.89 , Mjoen G.89 , Pini S.90 , De Biase C. , Van De Logt A.E. , Maas R.91 , Lebedeva O.92 , Lopez V.93 , Reichert L.J.M.94 , Verhave J.94 , Titov D. 95 , Parshina E.V.96 , Van Gils-Verrij L.E.A. , De Bruin C.J.R. , Harty J.C.99 , Meurs M.100 , Myslak M.101 , Battaglia Y.102 , Lentini P.103 , Den Deurwaarder E. , Rahimzadeh H.105 , Schouten M.106 , Cabezas-Reina C.J.107 , Diaz-Mareque A.108 , Coca A.109 , Meijers B.K.I.110 , Naesens M.110 , Kuypers D.110 , Desschans B.110 , Tonnerlier A.111 , Wissing K.M.111 , Dedinska I.112 , Pessolano G.113 , Van Der Sande F.M. , Christiaans M.H.L.114 , Gandolfini I.115 , Maggiore U.115 , Kanaan N.116 , Labriola L.116 , Devresse A.116 , Malik S.117 , Berger S.P.118 , Meijer E.118 , Sanders J.S.F.118 , Ponikvar J.B.119 , Abrahams A.C.120 , Molenaar F.M.120 , Van Zuilen A.D. , Meijvis S.C.A.120 , Dolmans H.120 , Zanoli L.121 , Marcantoni C.121 , Esposito P.122 , Krzesinski J.-M.123 , Barahira J.D.123 , Gallieni M.124 , Sabiu G.124 , Martin-Moreno P.L.125 , Guglielmetti G.126 , Guzzo G.127 , Luik A.J.128 , Van Kuijk W.H.M. , Stikkelbroeck L.W.H.128 , Hermans M.M.H.128 , Rimsevicius L.129 , Righetti M.130 , Heitink-Ter Braak N. , ERACODA Collaborators
Journal
NEPHROLOGY DIALYSIS TRANSPLANTATION
Publisher
Oxford University Press
Number of issue
11
Language
English
Pages
1973-1983
Status
Published
Link
External link
DOI
10.1093/NDT/GFAA261
Volume
35
Year
2020
Organizations
  • 1 Department of Nephrology, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
  • 2 Department of Health Evidence, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
  • 3 Department of Cardiology, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
  • 4 Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  • 5 Dutch Renal Registry, Nefrovisie Foundation, Utrecht, Netherlands
  • 6 ERA-EDTA Registry, Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
  • 7 Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, Netherlands
  • 8 Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  • 9 Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
  • 10 Dr Ci Parhon Hospital, Iasi, Romania
  • 11 Department of Nephrology, Hospital del Mar, Barcelona, Spain
  • 12 Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
  • 13 Department of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey
  • 14 Division of Nephrology, Ambroise Paré University Hospital, APHP (Assistance Publique-Hôpitaux de Paris), UVSQ (University Versailles-Saint-Quentin-en-Yvelines) - Paris Saclay, Boulogne Billancourt, Paris, France
  • 15 Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
  • 16 Department of Nephrology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
  • 17 Centrodial, São João da Madeira, Portugal
  • 18 Renal Transplant Unit, Toledo University Hospital, Toledo, Spain
  • 19 Department of Nephrology, Hospital Universitario de Cabuenes, Asturias, Spain
  • 20 Department of Renal Unit, Lister Hospital, Stevenage, United Kingdom
  • 21 Institute of Nephrology, City Hospital Waid and Triemli, Zürich, Switzerland
  • 22 Albert Schweitzer Hospital, Dordrecht, Netherlands
  • 23 Ambroise Pare Hospital, APHP Paris-Saclay University, Boulogne Billancourt, France
  • 24 Amphia Hospital, Breda, Netherlands
  • 25 Amsterdam UMC, Amsterdam, Netherlands
  • 26 Antwerp University Hospital, Antwerp, Belgium
  • 27 Avicennes Military Hospital, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
  • 28 B. Braun Avitum, Litomerice, Czech Republic
  • 29 Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
  • 30 Bernhoven Hospital, Uden, Netherlands
  • 31 Catharina Hospital, Eindhoven, Netherlands
  • 32 Centre of Postgraduate Medical Education, Poland
  • 33 Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
  • 34 Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
  • 35 Charles University, Prague, Czech Republic
  • 36 City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
  • 37 City Hospital Waid, Zürich, Switzerland
  • 38 Claude Galien Hospital Ramsay Santé, Quincy-sous-Sénart, France
  • 39 Clínica de Hemodiálise de Felgueiras, Felgueiras, Portugal
  • 40 Clinical Centre of Vojvodina, Novi Sad, Serbia
  • 41 Croatian Society of Nephrology, Dialysis and Transplantation, Croatia
  • 42 CWZ Nijmegen, Nijmegen, Netherlands
  • 43 DaVita Geilenkirchen, Geilenkirchen, Germany
  • 44 Dianet Dialysis Center, Utrecht, Netherlands
  • 45 Dialysis Center Bochum, Bochum, Germany
  • 46 Deventer Ziekenhuis, Deventer, Netherlands
  • 47 Elyse Klinieken voor Nierzorg, Kerkrade, Netherlands
  • 48 Erasme Hospital, Brussels, Belgium
  • 49 Erasmus Medical Center, Rotterdam, Netherlands
  • 50 Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
  • 51 Faculty of Medicine-Alexandria University, Alexandria, Egypt
  • 52 Epidemiology Department, High Institute of Public Health, Alexandria University, Egypt
  • 53 Fundación Jiménez Díaz, Madrid, Spain
  • 54 Gdansk Medical University, Gdansk, Poland
  • 55 Gelre Hospital, Apeldoorn, Netherlands
  • 56 General University Hospital of Alexandroupolis, Alexandroupolis, Greece
  • 57 Haaglanden Medisch Centrum, the Hague, Netherlands
  • 58 Haga Hospital, the Hague, Netherlands
  • 59 Hospital Clínic de Barcelona, Barcelona, Spain
  • 60 Hospital Curry Cabral, Central Lisbon University Hospital Center, Lisbon, Portugal
  • 61 HC-UFMG, CMN Contagem-MG, Unimed-BH, Brazil
  • 62 Hospital del Mar, Barcelona, Spain
  • 63 Hospital Gelderse Vallei, Ede, Netherlands
  • 64 Hospital General of Alicante, Alicante, Spain
  • 65 Hospital General Universitario Gregorio Marañón, Madrid, Spain
  • 66 Hospital Obispo Polanco, Salud Aragón, Spain
  • 67 Hospital Universitario de Guadalajara, Guadalajara, Spain
  • 68 Hospital Universitario Ramón y Cajal, Madrid, Spain
  • 69 Isala, Zwolle, Netherlands
  • 70 Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  • 71 Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands
  • 72 Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
  • 73 Leiden University Medical Center, Leiden, Netherlands
  • 74 Lithuanian University of Health Sciences, Lithuania
  • 75 Luzerner Kantonsspital, Luzern, Switzerland
  • 76 Maasstad Ziekenhuis, Rotterdam, Netherlands
  • 77 Marche Nord Hospital, Pesaro, Italy
  • 78 Marmara University School of Medicine, Istanbul, Turkey
  • 79 Maxima Medisch Centrum, Veldhoven, Netherlands
  • 80 Meander Medisch Centrum, Amersfoort, Netherlands
  • 81 Medical University Innsbruck, Innsbruck, Austria
  • 82 Medical University of Vienna, Vienna, Austria
  • 83 Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
  • 84 Moscow Regional Research and Clinical Institute, Moscow, Russian Federation
  • 85 Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
  • 86 Nephrology and Dialysis - AUSL Modena, Modena, Italy
  • 87 Nierenzentrum Reutlingen-Tübingen, Reutlingen, Germany
  • 88 Okinawa Chubu Hospital, Japan
  • 89 The Norwegian Renal Registry, Oslo University Hospital - Rikshospitalet, Olso, Norway
  • 90 Padua University Hospital, Padua, Italy
  • 91 Radboud University Medical Center, Nijmegen, Netherlands
  • 92 Regional Clinical Hospital, Yaroslavl, Russian Federation
  • 93 Regional Hospital of Malaga, Malaga, Spain
  • 94 Rijnstate Hospital, Arnhem, Netherlands
  • 95 RUDN University, Russian Federation
  • 96 Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
  • 97 Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
  • 98 Slingeland Ziekenhuis, Doetinchem, Netherlands
  • 99 Southern Health and Social Care Trust, Newry, United Kingdom
  • 100 Spaarne Gasthuis, Haarlem, Netherlands
  • 101 SPWSZ Hospital, Szczecinie, Poland
  • 102 St. Anna University Hospital, Ferrara, Italy
  • 103 St. Bassiano Hospital, Bassano del Grappo, Italy
  • 104 Streekziekenhuis Koningin Beatrix, Winterswijk, Netherlands
  • 105 Tehran University of Medical Sciences, Theran, Iran
  • 106 Tergooi, Hilversum, Netherlands
  • 107 Toledo University Hospital, Toledo, Spain
  • 108 University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
  • 109 University Clinical Hospital of Valladolid, Valladolid, Spain
  • 110 University Hospital Leuven, Leuven, Belgium
  • 111 University Hospital Brussels, Brussels, Belgium
  • 112 University Hospital Martin and Jessenius, Faculty of Medicine, Comenius University, Martin, Slovakia
  • 113 University Hospital Medical Center Verona, Verona, Italy
  • 114 University Hospital of Maastricht, Maastricht, Netherlands
  • 115 University Hospital Parma, Parma, Italy
  • 116 University Hospital UC Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
  • 117 University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
  • 118 University Medical Center Groningen, Groningen, Netherlands
  • 119 University Medical Center Ljubljana, Ljubljana, Slovenia
  • 120 University Medical Center Utrecht, Utrecht, Netherlands
  • 121 San Marco Hospital, University of Catania, Catania, Italy
  • 122 University of Genoa, Genoa, Italy
  • 123 University of Liège, Liège, Belgium
  • 124 University of Milan, Milan, Italy
  • 125 University of Navarra Clinic, Pamplona, Spain
  • 126 University of Piemonte Orientale, Novara, Italy
  • 127 Valais Hospital, Sion, Switzerland
  • 128 VieCuri Medical Centre, Venlo, Netherlands
  • 129 Vilnius University, Vilnius, Lithuania
  • 130 Vimercate Hospital, Vimercate, Italy
  • 131 Zuyderland Medical Center, Geleen and Heerlen, Netherlands
Keywords
COVID-19; Dialysis; Kidney; Mortality; Transplantation
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