tetano
Editor, Senior Moderator
Clin Kidney J
. 2022 Jun 3;15(9):1685-1697.
doi: 10.1093/ckj/sfac135. eCollection 2022 Sep.
Evolving spectrum but persistent high mortality of COVID-19 among patients on kidney replacement therapy in the vaccine era: the Spanish COVID-19 KRT Registry
Borja Quiroga[SUP] 1 [/SUP], Alberto Ortiz[SUP] 2 [/SUP], Carlos Jesús Cabezas-Reina[SUP] 3 [/SUP], María Carmen Ruiz Fuentes[SUP] 4 [/SUP], Verónica López Jiménez[SUP] 5 [/SUP], Sofía Zárraga Larrondo[SUP] 6 [/SUP], Néstor Toapanta[SUP] 7 [/SUP], María Molina Gómez[SUP] 8 [/SUP], Patricia de Sequera[SUP] 9 [/SUP], Emilio Sánchez-Álvarez[SUP] 10 [/SUP], Spanish COVID-19 KRT Registry collaborative group
Affiliations
Abstract
Background: Kidney replacement therapy (KRT) conferred a high risk for coronavirus disease 2019 (COVID-19) related mortality early in the pandemic. We evaluate the presentation, treatment and outcomes of COVID-19 in patients on KRT over time during the pandemic.
Methods: This registry-based study involved 6080 dialysis and kidney transplant (KT) patients with COVID-19, representing roughly 10% of total Spanish KRT patients. Epidemiology, comorbidity, infection, vaccine status and treatment data were recorded, and predictors of hospital admission, intensive care unit (ICU) admission and mortality were evaluated.
Results: Vaccine introduction decreased the number of COVID-19 cases from 1747 to 280 per wave. Of 3856 (64%) COVID-19 KRT patients admitted to the hospital, 1481/3856 (38%) were admitted during the first of six waves. Independent predictors for admission included KT and the first wave. During follow-up, 1207 patients (21%) died, 500/1207 (41%) during the first wave. Among vaccinated patients, mortality was 19%, mostly affecting KT recipients. Overall, independent predictors for mortality were older age, disease severity (lymphopaenia, pneumonia) and ICU rejection. Among patient factors, older age, male sex, diabetes, KT and no angiotensin receptor blockers (ARB) were independent predictors of death. In KT recipients, individual immunosuppressants were independent predictors of death. Over time, patient characteristics evolved and in later pandemic waves, COVID-19 was mainly diagnosed in vaccinated KT recipients; in the few unvaccinated dialysis patients, ICU admissions increased and mortality decreased (28% for the first wave and 16-22% thereafter).
Conclusions: The clinical presentation and outcomes of COVID-19 during the first wave no longer represent COVID-19 in KRT patients, as the pandemic has become centred around vaccinated KT recipients. Vaccines lowered the incidence of diagnosed COVID-19 and mortality. However, mortality remains high despite increased access to ICU care.
Keywords: COVID-19; SARS-CoV-2; dialysis; kidney transplant; mortality.
. 2022 Jun 3;15(9):1685-1697.
doi: 10.1093/ckj/sfac135. eCollection 2022 Sep.
Evolving spectrum but persistent high mortality of COVID-19 among patients on kidney replacement therapy in the vaccine era: the Spanish COVID-19 KRT Registry
Borja Quiroga[SUP] 1 [/SUP], Alberto Ortiz[SUP] 2 [/SUP], Carlos Jesús Cabezas-Reina[SUP] 3 [/SUP], María Carmen Ruiz Fuentes[SUP] 4 [/SUP], Verónica López Jiménez[SUP] 5 [/SUP], Sofía Zárraga Larrondo[SUP] 6 [/SUP], Néstor Toapanta[SUP] 7 [/SUP], María Molina Gómez[SUP] 8 [/SUP], Patricia de Sequera[SUP] 9 [/SUP], Emilio Sánchez-Álvarez[SUP] 10 [/SUP], Spanish COVID-19 KRT Registry collaborative group
Affiliations
- PMID: 35999961
- PMCID: PMC9214101
- DOI: 10.1093/ckj/sfac135
Abstract
Background: Kidney replacement therapy (KRT) conferred a high risk for coronavirus disease 2019 (COVID-19) related mortality early in the pandemic. We evaluate the presentation, treatment and outcomes of COVID-19 in patients on KRT over time during the pandemic.
Methods: This registry-based study involved 6080 dialysis and kidney transplant (KT) patients with COVID-19, representing roughly 10% of total Spanish KRT patients. Epidemiology, comorbidity, infection, vaccine status and treatment data were recorded, and predictors of hospital admission, intensive care unit (ICU) admission and mortality were evaluated.
Results: Vaccine introduction decreased the number of COVID-19 cases from 1747 to 280 per wave. Of 3856 (64%) COVID-19 KRT patients admitted to the hospital, 1481/3856 (38%) were admitted during the first of six waves. Independent predictors for admission included KT and the first wave. During follow-up, 1207 patients (21%) died, 500/1207 (41%) during the first wave. Among vaccinated patients, mortality was 19%, mostly affecting KT recipients. Overall, independent predictors for mortality were older age, disease severity (lymphopaenia, pneumonia) and ICU rejection. Among patient factors, older age, male sex, diabetes, KT and no angiotensin receptor blockers (ARB) were independent predictors of death. In KT recipients, individual immunosuppressants were independent predictors of death. Over time, patient characteristics evolved and in later pandemic waves, COVID-19 was mainly diagnosed in vaccinated KT recipients; in the few unvaccinated dialysis patients, ICU admissions increased and mortality decreased (28% for the first wave and 16-22% thereafter).
Conclusions: The clinical presentation and outcomes of COVID-19 during the first wave no longer represent COVID-19 in KRT patients, as the pandemic has become centred around vaccinated KT recipients. Vaccines lowered the incidence of diagnosed COVID-19 and mortality. However, mortality remains high despite increased access to ICU care.
Keywords: COVID-19; SARS-CoV-2; dialysis; kidney transplant; mortality.