One-year impact of COVID-19 pandemic on renal replacement therapy and kidney transplantation in a tertiary center in Southern Brazil

Abstract

Introduction: Patients on renal replacement therapy (RRT) and kidney transplant recipients (KTR) present multiple factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). This study aimed to evaluate the incidence and impact of COVID-19 in RRT patients and KTRs. Methods: Between March 2020 and February 2021, we monitored the RRT population of thirteen dialysis facilities that refer patients for transplantation to our center, a tertiary hospital in Southern Brazil. In the same period, we also monitor COVID-19 incidence and mortality in our KTR population. Demographical, clinical, and COVID-19-related information were analyzed. Results: We evaluated 1545 patients in the dialysis centers, of which 267 (17.4%) were infected by COVID-19 and 53 (19.9%) died. Among 275 patients on the kidney transplant waiting list, 63 patients (22.9%) were infected and seven (11.1%) died. COVID-19 was the leading cause of death (29.2%) among patients on the waiting list. Within the population of 1360 KTR, 134 (9.85%) were diagnosed with COVID-19 and 20 (14.9%) died. The number of kidney transplants decreased by 56.7% compared with the same period in the previous twelve months. Conclusion: In the study period, patients on RRT and KTRs presented a high incidence of COVID-19 and high COVID-19-related lethality. The impact on the patients on the transplant waiting list was less pronounced. The lethality rate observed in both cohorts seems to be related to age, comorbidities, and disease severity.

Transplantar ou não transplantar durante uma pandemia?

“…O estudo de Teichmann et al 2 , realizado antes da disponibilidade das vacinas, analisou a incidência, letalidade e fatores de risco associados à COVID-19 em pacientes em hemodiálise, pacientes em lista de espera e em receptores de transplante renal. No período do estudo, pacientes em hemodiálise e receptores de transplante renal apresentaram alta incidência de infecção e alta letalidade relacionada à COVID-19.…”

“…O transplante renal é um procedimento altamente complexo e integrado que salva vidas. Apesar da hesitação inicial, diante dos achados relatados por Teichmann et al 2 , a decisão de manter e fomentar a atividade de transplante, considerando o ambiente local durante as fases evolutivas da pandemia de COVID-19, em retrospecto, parece ter sido a mais acertada.…”

To transplant or not to transplant during a pandemic?

“…The study by Teichmann et al 2 , performed before any vaccine was available, analyzed the incidence, lethality and risk factors associated with SARS-CoV-2 in patients receiving hemodialysis, patients on the waiting list for a kidney transplant, and in kidney transplant recipients. In the study period, patients receiving hemodialysis and recipients of kidney transplant presented a high incidence of COVID-19 and high COVID-19-related lethality.…”

“…Kidney transplant is a highly complex and integrated procedure that saves lives. Despite the initial hesitance, in view of the findings reported by Teichmann et al 2 , the decision to maintain and foment the transplant activity, considering the local environment during the evolving phases of the COVID-19 pandemic, in retrospect, appears to have been the right decision.…”