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
Quiroga, Borja (Hospital Universitario de la Princesa (Madrid))
Ortiz, Alberto (Universidad Autónoma de Madrid)
Cabezas-Reina, Carlos Jesús (Hospital Universitario de Toledo)
Ruiz Fuentes, María Carmen (Hospital Virgen de las Nieves)
Jiménez, Verónica López (Hospital Regional Universitario de Málaga)
Larrondo, Sofía Zárraga (Hospital Universitario de Cruces (Barakaldo, País Basc))
Toapanta, Néstor (Hospital Universitari Vall d'Hebron)
Gómez, María Molina (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
de Sequera, Patricia (Universidad Complutense de Madrid)
Sánchez-Álvarez, Emilio (Hospital Universitario Infanta Leonor)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	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. 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. 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). 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.
Grants:	Instituto de Salud Carlos III PI18/01366 Instituto de Salud Carlos III PI19/00588 Instituto de Salud Carlos III PI19/00815 Instituto de Salud Carlos III DTS18/00032 Instituto de Salud Carlos III AC18/00064 Instituto de Salud Carlos III AC18/00071
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	COVID-19 ; Dialysis ; Kidney transplant ; Mortality ; SARS-CoV-2
Published in:	Clinical Kidney Journal, Vol. 15 (june 2022) , p. 1685-1697, ISSN 2048-8513

DOI: 10.1093/ckj/sfac135
PMID: 35999961

13 p, 973.9 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles