Background
Kidney replacement therapy (KRT) conferred a high risk for COVID-19-related mortality early in the pandemic. We evaluated the presentation, treatment, and outcomes of COVID-19 in patients on KRT over time during the pandemic.
Methods
This registry-based study involved 6080 dialysis and kidney transplant (KT) patients with COVID-19, representing roughly 10% of total Spanish KRT patients. Epidemiology, comorbidity, infection, vaccine status and treatment data were recorded and predictors of hospital admission, intensive care unit (ICU) admission and mortality evaluated.
Results
Vaccine introduction decreased COVID-19 cases from 1747 to 280 per wave. Of 3856 (64%) COVID-19 KRT patients admitted to hospital, 1481/3856 (38%) were admitted during the first of six waves. Independent predictors for admission included KT and first wave.
During follow-up, 1207 patients (21%) died, 500/1207 (41%) during the first wave. Among vaccinated patients, mortality was 19%, mostly affecting KT recipients. Overall, independent predictors for mortality were older age, disease severity (lymphopenia, pneumonia) and ICU rejection. Among patient factors, older age, male sex, diabetes, KT, and no angiotensin receptor blockers were independent predictors of death. In KT recipients, individual immunosuppressants were independent predictors of death.
Over time, patient characteristics evolved and in later pandemic waves, COVID-19 was mainly diagnosed in vaccinated KT recipients and in the few unvaccinated dialysis patients, ICU admissions increased, and mortality decreased (28% for the first wave and 16-22% thereafter).
Conclusions
The clinical presentation and outcomes of COVID-19 during the first wave no longer represent COVID-19 in KRT patients, as the pandemic has become centred around vaccinated KT recipients. Vaccines lowered the incidence of diagnosed COVID-19 and mortality. However, mortality remains high despite increased access to ICU care.
