Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study

Abstract

Background and objectives Patients undergoing kidney replacement therapies (KRTs) have a poor prognosis after Covid-19 infection. Few studies have compared the outcomes of such patients in the different KRT modalities. This study aimed to analyze the 30-day Covid-19-associated case-fatality rate of dialysis and kidney transplant patients. Methods Retrospective cohort study analyzing data from patients with confirmed Covid-19 between Mar/20 and Jan/21 included in two multicenter studies, the Brazilian Covid-19 Dialysis Study (Dialysis group, n = 703) and the Covid-19-KT Brazilian Study (Transplant group, n = 1907). To assess the risk factors for death, adjusted Cox hazards models were used.A sensitivity analysis was performed using a propensity score analysis to match the groups (n = 587 patients in each group). Results A higher percentage of transplant patients required hospitalization (68 vs. 51%, p < 0.001), intensive care (37 vs. 30%, p = 0.023), and invasive mechanical ventilation (28 vs. 22%, p = 0.035). Multivariate analysis of the before-matching sample showed that subjects in the transplant group were at a lower death risk at baseline (HR 0.38 0.56 0.85 ). However, they showed higher risk over time (HR 1.03 1.06 1.09 ). Kaplan-Meier analysis after propensity score matching confirmed the inferior 30-day cumulative survival in the transplant recipients (83 vs. 78%, p = 0.0014). Conclusion Both transplant and dialysis patients have high 30-day case-fatality rates after a Covid-19 diagnosis. Despite lower death risk at baseline, transplant patients have an increased death risk of 6% per day than dialysis patients.

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

“…Moreover, a propensity match score analysis in Brazilian populations of KTR and patients on RRT showed that both cohorts had increased 30-day mortality after COVID-19 diagnosis. KTR, despite lower death risk at baseline, presented an increased risk of death than dialysis patients 19 .…”

Impacto de um ano da Pandemia COVID 19 na terapia renal substitutiva e no transplante renal em centro terciário no Sul do Brasil

“…Além disso, uma análise utilizando escore de propensão em populações brasileiras de RTR e pacientes em TRS mostrou que ambas as coortes haviam aumentado a mortalidade em 30 dias após o diagnóstico da COVID-19. Os RTR, apesar do menor risco de óbito no início, apresentaram um risco maior de óbito do que pacientes em diálise 19 .…”

“…No presente estudo, avaliamos o impacto de um ano da pandemia do SARS-CoV-2 na TRS e no transplante renal em um centro terciário localizado no estado do Rio Grande do Sul, Brasil, que se tornou um centro de referência no tratamento de casos graves de pacientes com COVID- 19.…”

Impacto da Imunossupressão na Gravidade da Infecção por Sars-CoV-2 em Transplantados Renais

“…Como resultado, os transplantados apresentaram risco de morte em 30 dias 6% maior a cada dia de seguimento após o diagnóstico. 6 Além do pior desfecho clínico após a infecção pelo novo coronavírus, os pacientes transplantados apresentam prolongamento da eliminação viral e menor resposta vacinal, notadamente menores taxas de soroconversão e declínio mais rápido dos títulos de anticorpos neutralizantes quando comparados à população geral. 5,[7][8][9][10] Como resultado, evidências recentes demonstram que pacientes transplantados que receberam uma ou duas doses de vacina contra o Sars-CoV-2 têm desfechos clínicos semelhantes aos de pacientes não vacinados, o que reforça a necessidade de doses complementares nesse grupo de indivíduos.…”