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

Kitty J Jager ,Rebecca Winzeler ,Anneke Kramer ,Gert Mayer ,Tiny Hoekstra ,Julia Kerschbaum ,Vianda S Stel ,Lionel Mazzoleni ,María Dolores Del Pino Y Pino ,Camille Legeai ,Carmine Zoccali ,Gabriel Mircescu ,Marc H Hemmelder ,Liliana Gârneaţă ,Cécile Couchoud ,J Emilio Sánchez-Álvarez ,Christoph Wanner ,Frédéric Collart ,Nicholas C Chesnaye ,Patrice M Ambühl ,Ziad A Massy

doi:10.1016/j.kint.2020.09.006

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-19–attributable 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.

Highlights

The aim of this study was to investigate 28-day mortality after COVID-19 diagnosis in the European kidney replacement therapy population
Patient population From February 1, 2020, to April 30, 2020, a total of 4298 Kidney replacement therapy (KRT) patients were diagnosed with COVID-19, of which 3285 (76.4%) were on dialysis—3160 on hemodialysis and 125 on peritoneal dialysis—and 1013 (23.6%) were living with a functioning transplant (Table 1)
Two-thirds were $65 years of age, almost twothirds were male, almost half suffered from either diabetes mellitus (25.5%) or hypertension/renovascular disease (RVD) (21.2%) as primary renal disease (PRD), and 96.2% were on hemodialysis

Summary

Introduction

The aim of this study was to investigate 28-day mortality after COVID-19 diagnosis in the European kidney replacement therapy population. Additional data on all patients with a diagnosis of COVID-19 were collected from 7 European countries encompassing 4298 patients. COVID-19– attributable 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-

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