COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration
Authors: Hilbrands Luuk B , Duivenvoorden Raphaël , Vart Priya , Franssen Casper F M , Hemmelder Marc H , Jager Kitty J , Kieneker Lyanne M , Noordzij Marlies , Pena Michelle J , Vries Hanne de , Arroyo David , Covic Adrian , Crespo Marta , Goffin Eric , Islam Mahmud , Massy Ziad A , Montero Nuria , Oliveira João P , Roca Muñoz Ana , Sanchez J Emilio , Sridharan Sivakumar , Winzeler Rebecca , Gansevoort Ron T ,   ERACODA Collaborators, van der Net Jeroen B , Essig Marie , du Buf-Vereijken Peggy W G , van Ginneken Betty , Maas Nanda , Vogt Liffert , van Jaarsveld Birgit C , Bemelman Frederike J , Klingenberg-Salahova Farah , Heenan-Vos Frederiek , Vervloet Marc G , Nurmohamed Azam , Abramowicz Daniel , Verhofstede Sabine , Maoujoud Omar , Fialova Jana , Melilli Edoardo , Favà Alex , Cruzado Josep M , Lips Joy , Hengst Maaike , Gellert Ryszard , Rydzewski Andrzej , Alferes Daniela G , Rychlik Ivan , Zakharova Elena V , Ambuehl Patrice Max , Lepeytre Fanny , Rabaté Clémentine , Rostoker Guy , Marques Sofia , Azasevac Tijana , Katicic Dajana , Dam Marc ten , Krüger Thilo , Logtenberg Susan J J , Fricke Lutz , van Zanen A L , Slebe Jeroen J P , Kemlin Delphine , van de Wetering Jacqueline , Eiselt Jaromir , Kielberger Lukas , El-Wakil Hala S , ElHafeez Samar Abd , Canal Christina , Facundo Carme , Ramos Ana M , Debska-Slizien Alicja , Veldhuizen Nicoline M H , Panagoutsos Stylianos , Matceac Irina , Nistor Ionut , Cordos Monica , Groeneveld J H M , van Buren Marjolijn , Diekmann Fritz , Ferreira Ana C , Santos Augusto Cesar S , Arias-Cabrales Carlos , Llinàs-Mallol Laura , Buxeda Anna , Tàrrega Carla Burballa , Redondo-Pachon Dolores , Jimenez Maria Dolores Arenas , Hofstra Julia M , Franco Antonio , Rodríguez-Ferrero María L , Manzanos Sagrario Balda , de Arriba Gabriel , Haridian Sosa Barrios R , Bartelet Karlijn , Demir Erol , Hollander Daan A M J , Kerckhoffs Angele , Büttner Stefan , de Vries Aiko P.J , Meziyerh Soufian , van der Helm Danny , Reinders Marlies , Bouwsma Hanneke , Petruliene Kristina , Maloney Sharon , Verberk Iris , Di Luca Marina , Tuğlular Serhan Z , Beerenhout Charles , Luik Peter T , Kerschbaum Julia , Tiefenthaler Martin , Watschinger Bruno , Adema Aaltje Y , Stepanov Vadim A , Zulkarnaev Alexey B , Turkmen Kultigin , Decenzio Bonucchi , Fliedner Anselm , Miyasato Hitoshi , Åsberg Anders , Mjoen Geir , Pini Stefano , de Biase Consuelo , van de Logt Anne Els , Maas Rutger , Lebedeva Olga , Lopez Veronica , Reichert Louis J M , Verhave Jacobien , Titov Denis , Parshina Ekaterina V , van Gils-Verrij Liesbeth E A , de Bruin Charlotte J R , Harty John C , Meurs Marleen , Myslak Marek , Battaglia Yuri , Lentini Paolo , den Deurwaarder Edwin , Rahimzadeh Hormat , Schouten Marcel , Cabezas-Reina Carlos J , Diaz-Mareque Anabel , Coca Armando , Meijers Björn K I , Naesens Maarten , Kuypers Dirk , Desschans Bruno , Tonnerlier Annelies , Wissing Karl M , Dedinska Ivana , Pessolano Giuseppina , van der Sande Frank M , Christiaans Maarten H L , Gandolfini Ilaria , Maggiore Umberto , Kanaan Nada , Labriola Laura , Devresse Arnaud , Malik Shafi , Berger Stefan P , Meijer Esther , Sanders Jan Stephan F , Ponikvar Jadranka Buturović , Abrahams Alferso C , Molenaar Femke M , van Zuilen Arjan D , Meijvis S C A , Dolmans Helma , Zanoli Luca , Marcantoni Carmelita , Esposito Pasquale , Krzesinski Jean-Marie , Barahira Jean Damacène , Gallieni Maurizio , Martin-Moreno Paloma Leticia , Guglielmetti Gabriele , Guzzo Gabriella , Luik Antinus J , van Kuijk Willi H M , Stikkelbroeck Lonneke W H , Hermans Marc M H , Rimsevicius Laurynas , Righetti Marco , Braak Nicole Heitink-ter 
Published: September 2020

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 &lt;1 year before presentation (HR adjusted for sex, age and frailty 0.20, 95% CI 0.07–0.56, P &lt; 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.