COVID-19-related mortality in kidney transplant and haemodialysis patients: a comparative, prospective registry-based study
Authors: Goffin Eric , Candellier Alexandre , Vart Priya , Noordzij Marlies , Arnol Miha , Covic Adrian , Lentini Paolo , Malik Shafi , Reichert Louis J , Sever Mehmet S , Watschinger Bruno , Jager Kitty J , Gansevoort Ron T ,   ERACODA Collaborators, van der Net Jeroen B , Essig Marie , du Buf-Vereijken Peggy W G , van Ginneken Betty , Vogt Liffert , van Jaarsveld Brigit C , Bemelman Frederike J , Klingenberg-Salahova Farah , Heenan-Vos Frederiek , Vervloet Marc G , Nurmohamed Azam , Abramowicz Daniel , Verhofstede Sabine , Maoujoud Omar , Malfait Thomas , Avitum B Braun , Fialova Jana , Melilli Edoardo , Favà Alexandre , Cruzado Josep M , Perez Nuria Montero , Lips Joy , Krepel Harmen , Adilovic Harun , Hengst Maaike , Rydzewski Andrzej , Gellert Ryszard , Oliveira João , Alferes Daniela G , Zakharova Elena V , Ambuehl Patrice Max , Walker Andrea , Winzeler Rebecca , Lepeytre Fanny , Rabaté Clémentine , Rostoker Guy , Marques Sofia , Azasevac Tijana , Katicic Dajana , ten Dam Marc , Krüger Thilo , Brzosko Szymon , Zanen Adriaan L , Logtenberg Susan J J , Fricke Lutz , Slebe Jeroen J P , Kemlin Delphine , van de Wetering Jacqueline , Reinders Marlies E J , Eiselt Jaromir , Kielberger Lukas , El-Wakil Hala S , Verhoeven Martine A M , Canal Cristina , Facundo Carme , Ramos Ana M , Debska-Slizien Alicja , Veldhuizen Nicoline M H , Tigka Eirini , Konsta Maria Anna Polyzou , Panagoutsos Stylianos , Mallamaci Francesca , Matceac Irina , Nistor Ionut , Cordos Monica , Groeneveld J H M , Jousma Jolanda , van Buren Marjolijn , ElHafeez Samar Abd , Diekmann Fritz , Pereira Tiago Assis , Santos Augusto Cesar S , Arias-Cabrales Carlos , Crespo Marta , Llinàs-Mallol Laura , Buxeda Anna , Tàrrega Carla Burballa , Redondo-Pachon Dolores , Jimenez Maria Dolores Arenas , Hofstra Julia M , Franco Antonio , Arroyo David , Rodríguez-Ferrero Maria Luisa , Manzanos Sagrario Balda , Sosa Barrios R Haridian , Ávila Gonçalo , Laranjinha Ivo , Mateus Catarina , Lemahieu Wim , Dirim Ahmet Burak , Demir Erol , Şafak Seda , Turkmen Aydin , Hollander Daan A M J , Büttner Stefan , de Vries Aiko P J , Meziyerh Soufian , van der Helm Danny , Mallat Marko , Bouwsma Hanneke , Sridharan Sivakumar , Petruliene Kristina , Maloney Sharon-Rose , Verberk Iris , van der Sande Frank M , Christiaans Maarten H L , Hemmelder Marc , N Mohan Kumar , Di Luca Marina , Tuğlular Serhan Z , Kramer Andrea , Beerenhout Charles , Luik Peter T , Kerschbaum Julia , Tiefenthaler Martin , Adema Aaltje Y , Stepanov Vadim A , Zulkarnaev Alexey B , Turkmen Kultigin , Fliedner Anselm , Åsberg Anders , Mjoen Geir , Miyasato Hitoshi , de Fijter Carola W H , Mongera Nicola , Pini Stefano , de Biase Consuelo , Duivenvoorden Raphaël , Hilbrands Luuk , Kerckhoffs Angele , Maas Rutger , Lebedeva Olga , Lopez Veronica , Verhave Jacobien , Titov Denis , Parshina Ekaterina V , Zanoli Luca , Marcantoni Carmelita , van Gils-Verrij Liesbeth E A , Harty John C , Meurs Marleen , Myslak Marek , Battaglia Yuri , den Deurwaarder Edwin , Stendahl Maria , Rahimzadeh Hormat , Schouten Marcel , Rychlik Ivan , Cabezas-Reina Carlos J , Roca Ana Maria , Nauta Ferdau , Kanaan Nada , Labriola Laura , Devresse Arnaud , Diaz-Mareque Anabel , Coca Armando , Meijers Björn K I , Naesens Maarten , Kuypers Dirk , Desschans Bruno , Tonnelier Annelies , Wissing Karl M , de Arriba Gabriel , Dedinska Ivana , Pessolano Giuseppina , Gandolfini Ilaria , Maggiore Umberto , Papachristou Evangelos , Franssen Casper F M , Berger Stefan P , Meijer Esther , Özyilmaz Akin , Sanders Jan Stephan F , Ponikvar Jadranka Buturović , Pernat Andreja Marn , Kovac Damjan , Ekart Robert , Abrahams Alferso C , Molenaar Femke M , van Zuilen Arjan D , Meijvis Sabine C A , Dolmans Helma , Tantisattamos Ekamol , Esposito Pasquale , Krzesinski Jean-Marie , Barahira Jean Damacène , Gallieni Maurizio , Sabiu Gianmarco , Martin-Moreno Paloma Leticia , Guglielmetti Gabriele , Guzzo Gabriella , Toapanta Nestor , Luik Antinus J , van Kuijk Willi H M , Stikkelbroeck Lonneke W H , Hermans Marc M H , Rimsevicius Laurynas , Righetti Marco , Islam Mahmud , Braak Nicole Heitink-ter 
Published: June 2021

Abstract

Background
Coronavirus disease 2019 (COVID-19) has exposed haemodialysis (HD) patients and kidney transplant (KT) recipients to an unprecedented life-threatening infectious disease, raising concerns about kidney replacement therapy (KRT) strategy during the pandemic. This study investigated the association of the type of KRT with COVID-19 severity, adjusting for differences in individual characteristics.

Methods
Data on KT recipients and HD patients diagnosed with COVID-19 between 1 February 2020 and 1 December 2020 were retrieved from the European Renal Association COVID-19 Database. Cox regression models adjusted for age, sex, frailty and comorbidities were used to estimate hazard ratios (HRs) for 28-day mortality risk in all patients and in the subsets that were tested because of symptoms.

Results
A total of 1670 patients (496 functional KT and 1174 HD) were included; 16.9% of KT and 23.9% of HD patients died within 28 days of presentation. The unadjusted 28-day mortality risk was 33% lower in KT recipients compared with HD patients {HR 0.67 [95% confidence interval (CI) 0.52–0.85]}. In a fully adjusted model, the risk was 78% higher in KT recipients [HR 1.78 (95% CI 1.22–2.61)] compared with HD patients. This association was similar in patients tested because of symptoms [fully adjusted model HR 2.00 (95% CI 1.31–3.06)]. This risk was dramatically increased during the first post-transplant year. Results were similar for other endpoints (e.g. hospitalization, intensive care unit admission and mortality &gt;28 days) and across subgroups.

Conclusions
KT recipients had a greater risk of a more severe course of COVID-19 compared with HD patients, therefore they require specific infection mitigation strategies.