Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe

Abstract

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.

Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA

“…Results from the ERA-EDTA Registry further support the high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe [ 22 ]. The 28-day mortality was 20.0% (95% CI 18.7–21.4%) in 3285 patients receiving dialysis and 19.9% (17.5–22.5%) in 1013 recipients of a kidney transplant.…”

“…The mortality rates in dialysis and transplant cohorts clearly demonstrate that these are high-risk populations [ 22 , 23 ]; given the discrepancies between risk factors in this population as compared with the general population [ 23 ], findings in the general population cannot and should not be extrapolated to end-stage kidney disease populations. There are other compelling reasons why the CKD population merits specific study.…”

The COVID-19 pandemic: consequences for nephrology

“…• Underlying chronic kidney disease (CKD) is a risk factor for severe disease and mortality in patients with COVID-19; COVID-19related mortality is higher in dialysis and transplant recipients than in the general population [1][2][3][4][5] . • Acute kidney injury (AKI) is an important complication of severe COVID-19; critically ill patients in the intensive care unitparticularly those on mechanical ventilation -are more likely than patients with milder disease to require dialysis, which is associated with higher mortality COVID-19, mainly in post-mortem examinations.…”

“…COVID-19-associated mortality is also high among dialysis and kidney transplant recipients as demonstrated by a population-based registry study of >4,000 patients with a diagnosis of COVID-19 who were receiving kidney replacement therapy (KRT) 5 . Among patients on dialysis (n = 3,285), the 28-day mortality risk was 21.1 times higher than the expected 1.2% mortality of propensity-score matched historical controls.…”

“…In both groups, the presence of multimorbidities also affected outcomes. Geographical differences also existed, which are likely associated with the extent of disease spread in different regions 5 .…”