Impact of different COVID-19 waves on kidney replacement therapy epidemiology and mortality: REMER 2020

Abstract

Background Kidney replacement therapy (KRT) confers the highest risk of death from COVID-19. However, most data refer to the early pandemic waves. Whole year analysis in comparison 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 (−1.75%) for the first time since records began and the number of kidney transplants (KT) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008–2019). The 2019 to 2020 increase in mortality was larger for KT (+68%) than for HD (+24%) or PD (+38%). The most common cause of death was infection (n = 419, 48% of deaths), followed by cardiovascular (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 death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.

Results of the first nationwide cohort study of outcomes in dialysis and kidney transplant patients before and after vaccination for COVID-19

“…During the COVID-19 pandemic, Sweden had a policy based on voluntary restrictions, unlike most other European countries [ 6 ]. Nevertheless, in relation to the period before the pandemic, outcomes in the KRT patients in the present study were in general comparable to outcomes reported from other countries [ 29 , 30 , 37 , 38 ]. It is possible that the spread of the infection may have been too rapid to control among at-risk populations, considering the large outbreak in the community during the first two waves [ 39 ].…”

“…A registry study from the US reported an even greater impact on mortality rates, with an 41% increase above the expected number of deaths among KTRs during the same period [ 29 ]. Among KRT patients in Madrid, Spain, a 35% higher mortality was found in 2020 as compared with before the pandemic [ 30 ]. The European Renal Registry reported a 28-day COVID-19-attributable mortality rate of ≈20% for both dialysis and transplant recipients [ 14 ].…”

The changing pattern of COVID‐19 infection in hemodialysis and peritoneal dialysis patients

“…Clinical severity of infection was greatest with the earlier wild-type and alpha COVID-19 variants compared to the later omicron variants, in keeping with reports of greater than 20% mortality for HD patients during the first wave of the pandemic. 3,6 In keeping with severity of the clinical presentation, laboratory investigations showed a greater inflammatory response, characterized by differences in PMN, PBL, CRP, but also markers of cardiovascular damage, NTproBNP and TnT, and activation of coagulation with increased fibrinogen and D-dimers. These results are in keeping with other reports in non-dialysis populations, with greater rises in TnT and NTproBNP, being associated with worse outcomes.…”

“…3,4 On the other hand, peritoneal dialysis (PD) being a home-based therapy does not potentially expose patients to greater risks of contracting COVID-19 compared to the haemodialysis population, and several studies have reported both a lower incidence of COVID-19 infections in PD patients and lower mortality. 5,6 However, as many HD centers introduced COVID-19 enhanced infection control measures during the first wave of COVID-19 infection, designed to reduce the rate of transmission between patient infection rates remained high. 7 These changes in clinical practice coupled with the introduction of vaccination programs, 8 have been reported to reduce infection rates 9 and mortality.…”

From Cell to Symptoms: The Role of SARS-CoV-2 Cytopathic Effects in the Pathogenesis of COVID-19 and Long COVID

“…Some other studies have shown long-term effects of COVID-19 on the kidney [181], and is considered a multifactorial cause, since this virus can directly infect renal podocytes and proximal tubular cells, resulting in acute tubular necrosis, protein loss in Bowman's capsule, collapsing glomerulopathy and mitochondrial involvement [182]. These pathophysiological mechanisms contribute to the increased mortality in hemodialysis patients infected with SARS-CoV-2 with a 12-month follow-up period [183]. Moreover, in kidney transplant patients who survived COVID-19 developed general symptoms of post-acute COVID-19 syndrome, and their laboratory tests yielded altered results, including a shorter activated partial thromboplastin time and elevated levels of fibrinogen and D-dimer, all compatible with a procoagulant state [184], thus contributing to multiorgan failure in some of them, associated with significant morbidity.…”