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

Abstract

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 ± 13 and 67 ± 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 = 0.18]. In the subset of dialysis patients who were a candidate for transplantation (n = 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.

Age and Multimorbidities as Poor Prognostic Factors for COVID-19 in Hemodialysis: a Lebanese National Study

“…Importantly, in all dialysis and general population's COVID-19 studies, the most consistent demographic risk factor for death was age. Our study con rmed the signi cant association of older age and death, which is also aligned with the ndings of the European ERACODA study [24]. Age was also identi ed as a risk factor for higher mortality in studies from the UK Renal Registry, from Japan and Spain [16,15,22].…”

“…reported by the ERACODA study of 26 European and North Mediterranean countries including 768 dialysis patients [24]. To our knowledge, this is the rst study that evaluates the number of comorbidities or multimorbidities as a risk factor for death in hemodialysis patients with COVID-19.…”

“…Other studies identi ed one or two of these poor prognostic factors. For instance, in the ERACODA study, obesity was found a risk factor but not diabetes, nor lung disease, nor coronary artery disease [24]. Diabetes had a trend to increase mortality in the French study but did not reach signi cance [14].…”

Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA

“…Mortality risk was 1.28 (95% CI 1.02–1.60) times higher in transplant recipients compared with age- and sex-matched dialysis patients. In both groups, mortality is in large part related to age and in dialysis patients also to frailty status [ 23 ]. In addition, frequent hospital attendance, as is needed for in-centre dialysis, may increase the risk of infection for end-stage kidney disease patients [ 24 ].…”

“…Emerging data revealed risk factors for severe COVID-19 among patients on kidney replacement therapy. The European Renal Association COVID-19 Database (ERACODA) cohort, established by the ERA-EDTA, showed that within dialysis and kidney transplant populations the risk conferred by classical risk factors for severe COVID-19 is completely different than in the general population [ 23 ]. For instance, in dialysis patients with COVID-19 [ n = 768, of which 192 (25%) died], the relative contribution of age to mortality is considerably less than in subjects from the general population.…”