The aim of this study was to investigate 28-day mortality after COVID-19 diagnosis in the European kidney replacement therapy population. In addition, we determined the role of patient characteristics, treatment factors, and country on mortality risk with the use of ERA-EDTA Registry data on patients receiving kidney replacement therapy in Europe from February 1, 2020, to April 30, 2020. Additional data on all patients with a diagnosis of COVID-19 were collected from 7 European countries encompassing 4298 patients. COVID-19attributable mortality was calculated using propensity score-matched historic control data and after 28 days of follow-up was 20.0% (95% confidence interval 18.7%-21.4%) in 3285 patients receiving dialysis and 19.9% (17.5%-22.5%) in 1013 recipients of a transplant. We identified differences in COVID-19 mortality across countries, and an increased mortality risk in older patients receiving kidney replacement therapy and male patients receiving dialysis. In recipients of kidney transplants ‡75 years of age, 44.3% (35.7%-53.9%) did not survive COVID-19. Mortality risk was 1.28 (1.02-1.60) times higher in transplant recipients compared with matched dialysis patients. Thus, the pandemic has had a substantial effect on mortality in patients receiving kidney replacement therapy, a highly vulnerable population due to underlying chronic kidney disease and a high prevalence of multimorbidity.

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Background: The rapid worldwide spread of COVID-19 has posed a serious threat to patients treated with kidney replacement therapy (KRT). Moreover, the impact of the disease on hemodialysis centers, the patients, and the health care workers is still not completely understood. Objective: We present the analysis of a COVID-19 outbreak in a hemodialysis center in Belgium and report the incidence, clinical course, and outcome of the disease. Design: A retrospective cross-sectional cohort study. Setting: A hemodialysis center during the COVID-19 outbreak. Patients: A total of 62 patients on maintenance hemodialysis at a tertiary care center in Belgium attended by 26 health care workers. Measurements: Baseline patients’ characteristics were retrieved. The incidence, clinical course, and outcome were reported. The differences between COVID-19 survivors and nonsurvivors were assessed along with the differences between COVID-19-hospitalized and nonhospitalized patients. The incidence of the disease and outcome of health care workers were also reported. Methods: Proportions for categorical variables were compared using the Fisher exact test and χ2. The Mann-Whitney rank sum test was used to compare continuous variables. Univariate analysis and a binomial logistic regression were used to explore variables as predictors of death. Results: Between March 6 and April 14, 2020, 40 of 62 (65%) patients tested positive for severe acute respiratory syndrome beta coronavirus 2 (SARS-CoV-2) along with 18 of 26 (69%) health care professionals. Twenty-five (63%) of the infected patients were hospitalized with a median time for hospitalization-to-discharge of 8 (interquartile range [IQR] = 4-12) days. Eleven (28%) COVID-19-related deaths were recorded with a median time for onset of symptoms-to-death of 9 (IQR = 5-14) days. Lymphocytopenia was prevalent among the cohort and was found in 9 of 11 (82%) reported deaths ( P = .4). There was no influence of the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on COVID-19-related deaths ( P = .3). Advanced age, cardiovascular disease (CVD), and obstructive sleep apnea syndrome were all found to be significantly related to death. Of the 18 infected health care professionals, 13 (72%) were symptomatic and 2 (11%) were hospitalized. There was no reported death among the health care workers. Limitations: Limited follow-up time compared with the course of the disease along with a small sample size. Conclusions: Patients treated with KRT show a high mortality rate secondary to COVID-19. CVD and age are shown to impact survival. Proactive measures must be taken to prevent the spread of the virus in such facilities. Trial Registration: Not applicable as this is a retrospective study.

The authors mistook the acronym of GBM for antiglioblastoma multiforme in GN guidelines 13.2.3. 1 The correct expansion of GBM is glomerular basement membrane. An example was given that a 22-year-old Caucasian female patient was diagnosed with ISN/RPS (International Society of Nephrology/Renal Pathology Society) class IV-S (A) lupus nephritis (LN) on renal biopsy. 1 The authors quoted a small retrospective study from Korea comparing cyclophosphamide (CYC) to mycophenolate mofetil (MMF), and concluded that MMF suffered from lack of long-term efficacy data and may be inferior to CYC. Thus, one might choose CYC as an induction agent in this patient. However, Korean patients might not be representative of their Caucasian counterparts. The EULAR/ERA-EDTA (Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association) guidelines 2 for LN pointed out that the Aspreva Lupus Management Study (ALMS) trial, 3 the largest trial in LN showing comparable response rates between MMF and intravenous CYC, both administered for 6 months, together with the ease of administration, showed the more favorable gonadal toxicity profile of the MMF, and formed the basis for recommending MMF as initial treatment for most cases of class III-IV LN. The patient in the example was a young female, not pregnant yet. Given the favorable efficacy/ toxicity profile of MMF over intravenous CYC, especially in women of childbearing age and non-Asian patients, 4 it would be more appropriate for her to choose MMF rather than CYC.

Introduction Dès le début de l’épidémie du COVID-19, les centres de dialyse de Belgique francophone ont enregistré les cas de manière a établir un bulletin épidémiologique en temps réel sur base d’un questionnaire sur support papier d’abord, annexé au registre régional ensuite. Description Épidémiologie du COVID-19 en Belgique francophone entre mars et mai 2020. Méthodes Questionnaire patient portant sur la symptomatologie, le diagnostic et les dates-clé de l’évolution : date des premiers symptômes, du test de diagnostique, de l’hospitalisation éventuelle, du décès éventuel et de la sortie d’hospitalisation. Résultats Parmi 3619 patients dialysés au 1/1/2020 en Belgique francophone, 287 (7,9 %) ont présenté le COVID-19 avec une répartition très variable selon les sous-régions et les centres. Deux centres ont enregistré le plus grand nombre de cas (40 sur 64 patients [62,5 %] pour l’un, 35 sur 185 patients pour l’autre [19 %]). Cinquante-deux patients sont décédés (18 %). Suivant les centres, la stratégie diagnostique était la RT-PCR ou la culture virale de dépistage systématique. Les deux groupes d’âges les plus atteints étaient les 65–74 ans et 75–84 ans, la toute grande majorité étant des patients en hémodialyse, seuls 8 cas ont été observés en dialyse à domicile. Chez les patients atteints, les néphropathies primitives les plus fréquentes étaient le diabète et les néphropathies hypertensives et les comorbidités principales étaient les cardiopathies ischémiques et congestives (64 %), les troubles de l’autonomie (28 %), les néoplasies sous-jacentes (22 %) et les pathologies pulmonaires, principalement la BPCO (15 %). La durée médiane d’évolution depuis le diagnostic des patients décédés a été de 8 jours. Conclusion En Belgique francophone entre mars et mi-mai 2020, 7,9 % de la population dialysée a contracté le COVID-19 dont 18 % sont décédés. Le moment d’apparition du virus, des politiques différentes en termes de dépistage ou d’isolement, la disponibilité en matériel sont probablement à l’origine de la grande hétérogénéité d’incidence observée entre les centres.