Impact of different COVID-19 waves on kidney replacement therapy epidemiology and mortality: REMER 2020
Authors: Carriazo Sol , Aparicio-Madre Manuel I , Tornero-Molina Fernando , Fernández-Lucas Milagros , Paraiso-Cuevas Vicente , González-Parra Emilio , del Río-Gallegos Francisco , Marques-Vidas María , Alcázar-Arroyo Roberto , Martins-Muñoz Judith , Sánchez-Villanueva Rafael , Gil-Casares Beatriz , Gutiérrez-Martínez Eduardo , Martínez-Rubio María Pilar , Ortiz Alberto ,   for the REMER Committee, Diezhandino Maria Ángeles Goicoechea , Ferrero María Luisa Rodriguez , Estébanez Soraya Abad , Lucas Milagros Fernández , Mendiola Nuria Rodríguez , Domínguez Martha Díaz , Triviño Sandra Elias , Vion Victor Burguera , Martín Carlos Jiménez , Rubio Auxiliadora Bajo , Gutiérrez Rafael Selgas , Melgar Ángel Alonso , Román Laura Espinosa , Pérez José María Portolés , Sobrino Beatriz Sánchez , Carratalá Rosario Llópez , Calvo José Antonio Herrero , Flores Isabel Pérez , Fructuoso Ana Isabel Sánchez , Caro-Espada Paula Jara , Solís Elena Gutiérrez , Martín-Cleary Catalina , Verde Ana Ramos , Pérez Jesús Hernández , Cuadrado Guillermina Barril , González Martín Giorgi , Perpén Antonio Fernández , Carro Cristina Bernis , Miguel Patricia Martínez , Barrio María Fuensanta Moreno , Bouarich Hanane , Fernández María Pérez , Vergara Enrique Gruss , Juárez Gema María Fernández , Valcarce Eduardo Gallego , Ribera Ana Tato , Berrón Juan Carlos Herrero , Nieto María Teresa Naya , Alcaraz Alfonso Cubas , Molina Fernando Tornero , Casanova Beatriz Gil-Casares , Estévez Elda Besada , Cuevas Vicente Paraíso , García Jesús Benito , Pérez Alicia García , Prestel Valeria Sáiz , Ortiz Patricia de Sequera , Carrillo Rocío Echarri , Ojanguren M Covadonga Hevia , Herrero María del Carmen Jiménez , Alexandru Simona , Saico Saúl Enrique Pampa , Hernández Rosa Sánchez , González-Mariño Rocío Zamora , Jiménez Laura Rodríguez-Osorio , Gurpide Beatriz Durá , Cicero Elisa Ruiz , Sierra Cristina Albarracín , Lillo Ramón Delgado , Yagüe María Delgado , Alonso D Jorge Valencia , Gota Ángel Raquel , Guajardo Aurelio Sanz , Martín Carlos Jiménez , Pérez Jesús Hernández , Czerpak Karina Ruth Furaz , Abreu Ángel Agustín Méndez , Lorenzo Ana Botella , Sanz Javier Naranjo , Ares María Teresa Villaverde , Gasch Sandra Castellano , Rubio María del Pilar Martínez , Villanueva Patricia Nora Estrada , Alvarado José Ramón Berlanga , Santos Ana María Blanco , Matías Carmen Gámez , Hernández Pablo Mateos , Sainz Marta Sanz 
Published: August 2022

ABSTRACT

Background
Kidney replacement therapy (KRT) confers the highest risk of death from coronavirus disease 2019 (COVID-19). However, most data refer to the early pandemic waves. Whole-year analysis compared with prior secular trends are scarce.

Methods
We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19.

Results
In 2020, KRT incidence decreased 12% versus 2019, while KRT prevalence decreased by 1.75% for the first time since records began and the number of kidney transplants (KTs) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008–2019). The 2019–2020 increase in mortality was larger for KTs (+68%) than for haemodialysis (+24%) or peritoneal dialysis (+38%). The most common cause of death was infection [n = 419 (48% of deaths)], followed by cardiovascular [n = 200 (23%)]. Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths [209/285 (73%)] occurred during the first COVID-19 wave, which roughly accounted for the increased mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death.

Conclusions
COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating the death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.