Similar mortality for patients with COVID-19 on dialysis, kidney recipients with COVID-19
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Mortality among kidney transplant patients with COVID-19 and those on dialysis with COVID-19 was similar during the first and second waves of the pandemic in Europe.
“A number of studies compared mortality in the first and second waves among patients receiving kidney replacement therapy (KRT). These studies were hampered by the fact that they were single center by design and consequently had a small sample size,” Priya Vart, PhD, from the department internal medicine at the University Medical Center Groningen in The Netherlands, and colleagues wrote. “Furthermore, they lacked information on key patient and disease-related characteristics, including comorbidities, the reason for COVID-19 screening and disease symptoms.”
Researchers evaluated patients on dialysis and kidney transplant recipients with COVID-19 from across multiple centers in Europe during the first and second waves of the pandemic. The first wave of COVID-19 in Europe was defined as the period between March 2020 and July 2020, and the second wave as the period between August 2020 and February 2021.
Researchers compared mortality between the first and second waves among dialysis patients and kidney transplant recipients with COVID-19. Additionally, researchers considered reasons for differences in mortality between the waves.
Patients with dialysis
Among 3,004 patients with COVID-19 who were on dialysis, 1,253 were recorded during the first wave and 1,751 during the second wave. Researchers noted that the patients in the second wave were older, but there was no significant difference in gender.
Analyses revealed the crude 28-day mortality rate was lower and cumulative survival was higher among patients in the second wave than the first. While the hospitalization rate was significantly lower in the second wave, the in-hospital mortality was similar between the two waves.
Kidney transplant recipients
Of the 1,035 kidney transplant recipients with COVID-19, there were 475 recorded in the first wave and 560 in the second wave. Unlike patients on dialysis, the kidney transplant recipients who died of COVID-19 were younger during the second wave.
However, the 28-day mortality was lower in the second wave (12.9% vs. 18.7%) and cumulative survival was higher. Although hospitalizations were lower in the second wave, hospital mortality was consistent during both waves.
Potential reasons for differences in mortality
Researchers identified changes in screening intensity and the clinical management of patients on KTR with COVID-19 as potential explanations for the differences in mortality between the two pandemic waves.
“For instance, fewer anti-viral medications, more anti-inflammatory medications and less adjustment of immunosuppressants (mainly in kidney transplant recipients) were used during the second wave compared with the first wave,” Vart and colleagues wrote. They added, “However, the lack of an association between pandemic wave and mortality when accounted for disease severity suggests that the increased identification of less severe cases was the main reason for lower risk of mortality during the second wave.”
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