Key points• Chronic kidney disease is common and is associated with increased cardiovascular risk.• Attention to cardiovascular risk factors remains the cornerstone of care to delay progression of chronic kidney disease and prevent cardiovascular events.• Randomized clinical trials are lacking; thus, recommendations in the guidelines are based on a synthesis of the best available evidence.• Shared care of patients with chronic kidney disease by general practitioners and specialists is encouraged.

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Objective To determine whether people who donate a kidney have an increased risk of cardiovascular disease.Design Retrospective population based matched cohort study.Participants All people who were carefully selected to become a living kidney donor in the province of Ontario, Canada, between 1992 and 2009. The information in donor charts was manually reviewed and linked to provincial healthcare databases. Matched non-donors were selected from the healthiest segment of the general population. A total of 2028 donors and 20 280 matched non-donors were followed for a median of 6.5 years (maximum 17.7 years). Median age was 43 at the time of donation (interquartile range 34-50) and 50 at the time of follow-up (42-58).

populous province, almost 41 000 people had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), 1 which represented 0.3% of the provincial population. Close to 2800 people had died, a case fatality rate of 6.8%. 2 Patients undergoing dialysis have high rates of comorbid conditions, are often older adults, have varying degrees of immunosuppression and are more likely to reside in long-term care, which puts them at risk of both acquiring SARS-CoV-2 and developing complicated disease. 3,4 Furthermore, in Ontario, those who receive in-centre hemodialysis typically have 3 treatments per week in outpatient units located in or affiliated with hospitals, and the consequent inability to fully selfisolate means that patients undergoing hemodialysis likely have an even higher risk of SARS-CoV-2 infection. 3,4 Recent studies support this but do not compare infection rates with those in the local population of patients not undergoing dialysis. 5-10 Several studies have reported SARS-CoV-2 infection in single or multicentre cohorts of patients undergoing dialysis, 5-10 but we are unaware of any that have identified risk factors for infection at the level of a large region. Some studies have found that patients with SARS-CoV-2 infection who are undergoing dialysis are at high risk of severe illness and death. 6-10 Methods Study setting Ontario has a population of about 14.5 million. More than 12 000 people receive long-term dialysis, with about 74% receiving in-centre hemodialysis and 26% home dialysis, which comprises 21% peri toneal dialysis and 5% home hemodialysis. All dialysis in Ontario is funded by a single payer-the provincial government-operating through the Ontario Renal Network (ORN), a provincial agency that funds and manages services for patients with chronic kidney disease within 27 Renal Programs, which provide home dialysis services and operate more than 100 in-centre hemodialysis units. 11 The latter vary in size from 3 to 60 hemodialysis stations. To understand the impact of SARS-CoV-2 on RESEARCH VULNERABLE POPULATIONS COVID-19 in patients undergoing long-term dialysis in Ontario