Clinical triage of patients on kidney replacement therapy presenting with COVID-19: An ERACODA registry analysis

Background: Patients on kidney replacement therapy (KRT) are at very high risk of coronavirus disease 2019 (COVID-19). The triage pathway for KRT patients presenting to hospitals with varying severity of COVID-19 illness remains ill-defined. We studied the clinical characteristics of patients at initial and subsequent hospital presentations and the impact on patient outcomes. Methods: The European Renal Association COVID-19 Database (ERACODA) was analysed for clinical and laboratory features of 1423 KRT patients with COVID-19 either hospitalized or non-hospitalized at initial triage and those re-presenting a second time. Predictors of outcomes (hospitalization, 28-day mortality) were then determined for all those not hospitalized at initial triage. Results: Among 1423 KRT patients with COVID-19 [haemodialysis (HD), n = 1017; transplant, n = 406), 25% (n = 355) were not hospitalized at first presentation due to mild illness (30% HD, 13% transplant). Of the non-hospitalized patients, only 10% (n = 36) re-presented a second time, with a 5-day median interval between the two presentations (interquartile range 2-7 days). Patients who re-presented had worsening respiratory symptoms, a decrease in oxygen saturation (97% versus 90%) and an increase in C-reactive protein (26 versus 73 mg/L) and were older (72 vs 63 years) compared with those who did not return a second time. The 28-day mortality between early admission (at first presentation) and deferred admission (at second presentation) was not significantly different (29% versus 25%; P = 0.6). Older age, prior smoking history, higher clinical frailty score and self-reported shortness of breath at first presentation were identified as risk predictors of mortality when re-presenting after discharge at initial triage. Conclusions: This study provides evidence that KRT patients with COVID-19 and mild illness can be managed effectively with supported outpatient care and with vigilance of respiratory symptoms, especially in those with risk factors for poor outcomes. Our findings support a risk-stratified clinical approach to admissions and discharges of KRT patients presenting with COVID-19 to aid clinical triage and optimize resource utilization during the ongoing pandemic. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Authors
Mitra S.1 , Jayanti A.1 , Vart P.2, 3 , Coca A.4 , Gallieni M.5 , Øvrehus M.A.6 , Midtvedt K.7 , Abd Elhafeez S. , Gandolfini I.9 , Büttner S.10, 74 , Franssen C.F.M.3 , Hemmelder M.H.11, 12 , Van Der Net J.B. , Essig M.14 , Du Buf-Vereijken P.W.G. , Van Ginneken B. , Maas N.15 , Vogt L.16 , Van Jaarsveld B.C. , Jager K.J.16 , Bemelman F.J.16 , Klingenberg-Salahova F.16 , Heenan-Vos F.16 , Vervloet M.G.16 , Nurmohamed A.16 , Abramowicz D.17 , Verhofstede S.17 , Maoujoud O.18 , Malfait T.19 , Fialova J.20 , Melilli E.21 , Favà A.21 , Cruzado J.M.21 , Perez N.M.21 , Lips J.22 , Krepel H.23 , Adilovic H.24 , Hengst M.25 , Rydzewski A.26 , Gellert R.27 , Oliveira J.28 , Alferes D.G.29 , Zakharova E.V. 30 , Ambuehl P.M.31 , Walker A.31 , Winzeler R.31 , Lepeytre F.32 , Rabaté C.32 , Rostoker G.32 , Marques S.33 , Azasevac T.34 , Katicic D.35 , Dam M.T.36 , Krüger T.37 , Brzosko S.38 , Zanen A.L.39 , Logtenberg S.J.J.40 , Fricke L.41 , Slebe J.J.P.42 , Kemlin D.43 , Van De Wetering J. , Reinders M.E.J.44 , Eiselt J.45 , Kielberger L.45 , El-Wakil H.S.46 , Verhoeven M.A.M.47 , Canal C.48 , Facundo C.48 , Ramos A.M.49 , Debska-Slizien A.50 , Veldhuizen N.M.H.51 , Tigka E.52 , Konsta M.A.P.53 , Panagoutsos S.54 , Mallamaci F.55 , Postorino A.55 , Cambareri F.55 , Covic A.56, 57 , Matceac I.56, 57 , Nistor I.56, 57 , Cordos M.56, 57 , Groeneveld J.H.M.58 , Jousma J.58 , Marjolijn Van Buren , Diekmann F.60 , Tiago Assis Pereira , Santos A.C.S.62 , Arias-Cabrales C.63 , Crespo M.63 , Llinàs-Mallol L.63 , Buxeda A.63 , Tàrrega C.B.63 , Redondo-Pachon D.63 , Jimenez M.D.A.63 , Hofstra J.M.64 , Franco A.65 , Arroyo D.66 , Rodríguez-Ferrero M.L.66 , Manzanos S.B.67 , Barrios R.H.S.68 , Ávila G.69 , Laranjinha I.69 , Mateus C.69 , Lemahieu W.70 , Bartelet K.71 , Dirim A.B.72 , Sever M.S.72 , Demir E.72 , Şafak S.72 , Turkmen A.72 , Hollander D.A.M.J.73 , De Vries A.P.J. , Meziyerh S.75 , Van Der Helm D. , Mallat M.75 , Bouwsma H.75 , Sridharan S.76 , Petruliene K.77 , Maloney S.-R.78 , Verberk I.79 , Van Der Sande F.M. , Christiaans M.H.L.80 , Mohankumar N.81 , Di Luca M. , Tuǧlular S.Z.83 , Kramer A.84 , Beerenhout C.85 , Luik P.T.86 , Kerschbaum J.87 , Tiefenthaler M.88 , Watschinger B.89 , Adema A.Y.90 , Stepanov V.A.91 , Zulkarnaev A.B.91 , Turkmen K.92 , Fliedner A.93 , Åsberg A.94 , Mjoen G.94 , Miyasato H.95 , De Fijter C.W.H. , Mongera N.97 , Pini S.98 , De Biase C. , Duivenvoorden R.99 , Hilbrands L.99 , Kerckhoffs A.99 , Van De Logt A.-E. , Maas R.99 , Lebedeva O.100 , Lopez V.101 , Verhave J.102 , Reichert L.J.M.102 , Titov D. 103 , Parshina E.V.104 , Zanoli L.105 , Marcantoni C.105 , Van Gils-Verrij L.E.A. , Harty J.C.107 , Meurs M.108 , Myslak M.109 , Battaglia Y.110 , Lentini P.111 , Den Deurwaarder E. , Stendahl M.113 , Rahimzadeh H.114 , Schouten M.115 , Rychlik I.116 , Cabezas-Reina C.J.117 , Roca A.M.117 , Nauta F.118 , Goffin E.119 , Kanaan N.119 , Labriola L.119 , Devresse A.119 , Diaz-Mareque A.120 , Meijers B.K.I.121 , Naesens M.121 , Kuypers D.121 , Desschans B.121 , Tonnelier A.122 , Wissing K.M.122 , De Arriba G. , Dedinska I.124 , Pessolano G.125 , Maggiore U.126 , Malik S.127 , Papachristou E.128 , Gansevoort R.T.129 , Noordzij M.129 , Berger S.P.129 , Meijer E.129 , Özyilmaz A.129 , Sanders J.S.F.130 , Ponikvar J.B.131 , Arnol M.131 , Pernat A.M.131 , Kovac D.131 , Ekart R.132 , Abrahams A.C.133 , Molenaar F.M.133 , Van Zuilen A.D. , Meijvis S.C.A.133 , Dolmans H.133 , Tantisattamo E.134 , Esposito P.135 , Krzesinski J.-M.136 , Barahira J.D.136 , Sabiu G.137 , Martin-Moreno P.L.138 , Guglielmetti G.139 , Guzzo G.140 , Toapanta N.141 , Soler M.J.141 , Luik A.J.142 , Van Kuijk W.H.M. , Stikkelbroeck L.W.H.142 , Hermans M.M.H.142 , Rimsevicius L.143 , Righetti M.144 , Islam M.145 , Braak N.H.-T.146 , ERACODA Collaborators
Journal
NEPHROLOGY DIALYSIS TRANSPLANTATION
Publisher
Oxford University Press
Number of issue
12
Language
English
Pages
2308-2320
Status
Published
Link
External link
DOI
10.1093/NDT/GFAB196
Volume
36
Year
2021
Organizations
  • 1 Department of Renal Medicine, Manchester University Hospitals, Manchester Academy of Health Sciences Centre, Manchester, United Kingdom
  • 2 Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  • 3 Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  • 4 Department of Nephrology, University Clinical Hospital of Valladolid, Valladolid, Spain
  • 5 ASST Fatebenefratelli Sacco, University of Milano, Milan, Italy
  • 6 Department of Renal Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  • 7 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  • 8 Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
  • 9 University Hospital Parma, Parma, Italy
  • 10 Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
  • 11 Department Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands
  • 12 CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
  • 13 Albert Schweitzer Hospital, Dordrecht, Netherlands
  • 14 Ambroise Pare Hospital, APHP Paris-Saclay University, Boulogne Billancourt, France
  • 15 Amphia Hospital, Breda, Netherlands
  • 16 Amsterdam UMC, Amsterdam, Netherlands
  • 17 Antwerp University Hospital, Antwerp, Belgium
  • 18 Faculty of Medicine, Avicennes Military Hospital, Cadi Ayyad University, Marrakech, Morocco
  • 19 AZ Delta, Roeselare, Belgium
  • 20 B. Braun Avitum, Litomerice, Czech Republic
  • 21 Hospitalet de Llobregat, Bellvitge University Hospital, Barcelona, Spain
  • 22 Bernhoven Hospital, Uden, Netherlands
  • 23 Bravis Hospital, Roosendaal/Bergen op Zoom, Netherlands
  • 24 Cantonal Hospital Zenica, Bosnia and Herzegovina
  • 25 Catharina Hospital, Eindhoven, Netherlands
  • 26 Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
  • 27 Centre Hospitalier du Nord, Luxembourg and Centre of Postgraduate Medical Education, Warsaw, Poland
  • 28 Centrodial, Sao Joao da Madeira, Portugal
  • 29 Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
  • 30 City Hospital N.a. S.P. Botkin, Moscow, Russian Federation
  • 31 City Hospital Waid, Zürich, Switzerland
  • 32 Claude Galien Hospital Ramsay Santé, Quincy-sous-Senart, France
  • 33 Clínica de Hemodiálise de Felgueiras, Felgueiras, Portugal
  • 34 Clinical Centre of Vojvodina, Novi Sad, Serbia
  • 35 Croatian Society of Nephrology, Dialysis and Transplantation, Zagreb, Croatia
  • 36 CWZ Nijmegen, Nijmegen, Netherlands
  • 37 DaVita Geilenkirchen, Geilenkirchen, Germany
  • 38 DaVita, Wrocław, Poland
  • 39 Deventer Ziekenhuis, Deventer, Netherlands
  • 40 Dianet Dialysis Center, Utrecht, Netherlands
  • 41 Dialysis Center Bochum, Bochum, Germany
  • 42 Elyse Klinieken voor Nierzorg, Kerkrade, Netherlands
  • 43 Erasme Hospital, Brussels, Belgium
  • 44 Erasmus Medical Center, Rotterdam, Netherlands
  • 45 Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
  • 46 Faculty of Medicine, Alexandria University, Alexandria, Egypt
  • 47 Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
  • 48 Fundació Puigvert, Barcelona, Spain
  • 49 Fundación Jiménez Díaz, Madrid, Spain
  • 50 Gdansk Medical University, Gdansk, Poland
  • 51 Gelre Hospital, Apeldoorn, Netherlands
  • 52 General Hospital of Athens G. Gennimatas, Athens, United States
  • 53 General Hospital of Serres, Serres, Greece
  • 54 General University Hospital of Alexandroupolis, Alexandroupolis, Greece
  • 55 Grande Ospedale Metropolitano and CNR, Reggio Calabria, Italy
  • 56 Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
  • 57 Dr Ci Parhon Hospital, Iasi, Romania
  • 58 Haaglanden Medisch Centrum, Hague, Netherlands
  • 59 Haga Hospital, Hague, Netherlands
  • 60 Hospital Clínic de Barcelona, Barcelona, Spain
  • 61 Hospital Curry Cabral-Central Lisbon University Hospital Center, Lisbon, Portugal
  • 62 HC-UFMG, CMN Contagem-MG, Unimed-BH, Contagem, Brazil
  • 63 Hospital Del Mar, Barcelona, Spain
  • 64 Hospital Gelderse Vallei, Ede, Netherlands
  • 65 Hospital General of Alicante, Alicante, Spain
  • 66 Hospital General Universitario Gregorio Marañón, Madrid, Spain
  • 67 Hospital Obispo Polanco, Salud Aragon, Spain
  • 68 Hospital Universitario Ramón y Cajal, Madrid, Spain
  • 69 Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
  • 70 Imelda Hospital, Bonheiden, Belgium
  • 71 Isala, Zwolle, Netherlands
  • 72 Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  • 73 Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands
  • 74 Klinikum Aschaffenburg - Alzenau, Aschaffenburg, Germany
  • 75 Leiden University Medical Center, Leiden, Netherlands
  • 76 Lister Hospital, Stevenage, United Kingdom
  • 77 Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 78 Luzerner Kantonsspital, Luzern, Switzerland
  • 79 Maasstad Ziekenhuis, Rotterdam, Netherlands
  • 80 Maastricht University Medical Center, Maastricht, Netherlands
  • 81 Manipal Hospital, Bangalore, India
  • 82 Marche Nord Hospital, Pesaro, Italy
  • 83 Marmara University School of Medicine, Istanbul, Turkey
  • 84 Martini Ziekenhuis, Groningen, Netherlands
  • 85 Maxima Medisch Centrum, Veldhoven, Netherlands
  • 86 Meander Medisch Centrum, Amersfoort, Netherlands
  • 87 Austrian Dialysis and Transplant Registry, Rohr, Austria
  • 88 Medical University Innsbruck, Innsbruck, Austria
  • 89 Medical University of Vienna, Vienna, Austria
  • 90 Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
  • 91 Moscow Regional Research and Clinical Institute, Moscow, Russian Federation
  • 92 Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
  • 93 Nierenzentrum Reutlingen-Tübingen, Reutlingen, Germany
  • 94 Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Olso, Norway
  • 95 Okinawa Chubu Hospital, Nakagami, Japan
  • 96 OLVG, Amsterdam, Netherlands
  • 97 Ospedale S. Maurizio, Bolzano, Italy
  • 98 Padua University Hospital, Padua, Italy
  • 99 Radboud University Medical Center, Nijmegen, Netherlands
  • 100 Regional Clinical Hospital, Yaroslavl, Russian Federation
  • 101 Regional Hospital of Malaga, Malaga, Spain
  • 102 Rijnstate Hospital, Arnhem, Netherlands
  • 103 RUDN University, Moscow, Russian Federation
  • 104 Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
  • 105 San Marco Hospital, University of Catania, Catania, Italy
  • 106 Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
  • 107 Southern Health & Social Care Trust, Newry, United Kingdom
  • 108 Spaarne Gasthuis, Haarlem, Netherlands
  • 109 SPWSZ Hospital, Szczecinie, Poland
  • 110 St. Anna University Hospital, Ferrara, Italy
  • 111 St. Bassiano Hospital, Bassano del Grappo, Italy
  • 112 Streekziekenhuis Koningin Beatrix, Winterswijk, Netherlands
  • 113 Swedish Renal Registry, Jönköping, Sweden
  • 114 Tehran University of Medical Sciences, Tehran, Iran
  • 115 Tergooi, Hilversum, Netherlands
  • 116 Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
  • 117 Toledo University Hospital, Toledo, Spain
  • 118 Treant/Scheper Ziekenhuis, Emmen, Netherlands
  • 119 Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium
  • 120 University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
  • 121 University Hospital Leuven, Leuven, Belgium
  • 122 University Hospital Brussels, Brussels, Belgium
  • 123 Universitary Hospital of Guadalajara, Guadalajara, Spain
  • 124 University Hospital Martin, Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
  • 125 University Hospital Medical Center Verona, Verona, Italy
  • 126 University Hospitals Parma, Parma, Italy
  • 127 University Hospitals of Coventry, Warwickshire NHS Trust, Coventry, United Kingdom
  • 128 University Hospital of Patras, Patras, Greece
  • 129 Dialysis Center Groningen, Groningen, Netherlands
  • 130 University Medical Center Groningen, Groningen, Netherlands
  • 131 University Medical Center Ljubljana, Ljubljana, Slovenia
  • 132 University Medical Centre Maribor, Maribor, Slovenia
  • 133 University Medical Center Utrecht, Utrecht, Netherlands
  • 134 University of California Irvine School of Medicine, Orange, CA, United States
  • 135 University of Genoa, Genoa, Italy
  • 136 University of Liége, Liége, Belgium
  • 137 University of Milano, Milan, Italy
  • 138 University of Navarra Clinic, Pamplona, Spain
  • 139 University of Piemonte Orientale, Novara, Italy
  • 140 Valais Hospital, Sion, Switzerland
  • 141 Vall d'Hebron University Hospital, Barcelona, Spain
  • 142 VieCuri Medical Centre, Venlo, Netherlands
  • 143 Vilnius University, Vilnius, Lithuania
  • 144 Vimercate Hospital, Vimercate, Italy
  • 145 Zonguldak Ataturk State Hospital, Zonguldak, Turkey
  • 146 Zuyderland Medical Center, Geleen and Heerlen, Netherlands
Keywords
COVID-19; Dialysis; Kidney; Mortality; Second presentation; Transplantation
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