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oai:recercat.cat:11351/84192025-10-24T10:19:48Zcom_2072_378070com_2072_378040col_2072_378092

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 Cabezas-Reina, Carlos Jesús Ruiz Fuentes, María Carmen López Jiménez, Verónica Zárraga Larrondo, Sofía Toapanta Gaibor, Nestor Gabriel Ortiz Arduan, Alberto Quiroga, Borja Institut Català de la Salut [Quiroga B] IIS-La Princesa, Nephrology Department, Hospital de la Princesa, Madrid, Spain. [Ortiz A] IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain. [Cabezas-Reina CJ] Nephrology Department, Hospital Universitario de Toledo, Toledo, Spain. [Ruiz Fuentes MC] Nephrology Department, Hospital Virgen de las Nieves, Granada, Spain. [López Jiménez V] Nephrology Department, Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain. [Zárraga Larrondo S] Nephrology Department, Hospital Universitario de Cruces, Bizkaia, Spain. [Toapanta N] Servei de Nefrologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus COVID-19 (Malaltia) - Mortalitat Ronyons - Trasplantació - Mortalitat Registres mèdics DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections Other subheadings::Other subheadings::Other subheadings::Other subheadings::/mortality ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Renal Replacement Therapy ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Epidemiologic Methods::Data Collection::Registries ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus Otros calificadores::Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento de reemplazo renal TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::métodos epidemiológicos::recopilación de datos::registros COVID-19; Kidney transplant; Dialysis COVID-19; Trasplantament de ronyó; Diàlisi COVID-19; Trasplante de riñón; Diálisis 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. We want to thank all the implicated Spanish centres for their altruist collaboration. A.O. research is supported by FIS/Fondos FEDER [PI18/01366, PI19/00588, PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009)], Sociedad Española de Nefrología, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. Instituto de Salud Carlos III (ISCIII) RICORS program to RICORS2040 (RD21/0005/0001), FEDER funds. 2022-11-08T13:24:10Z 2022-11-08T13:24:10Z 2022-09 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Quiroga B, Ortiz A, Cabezas-Reina CJ, Fuentes MC, López Jiménez V, Zárraga Larrondo S, et al. 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. Clin Kidney J. 2022 Sep;15(9):1685–97. 2048-8513 https://hdl.handle.net/11351/8419 10.1093/ckj/sfac135 35999961 000824744600001 http://hdl.handle.net/11351/8419 eng Clinical Kidney Journal;15(9) https://doi.org/10.1093/ckj/sfac135 Attribution-NonCommercial 4.0 International http://creativecommons.org/licenses/by-nc/4.0/ info:eu-repo/semantics/openAccess application/pdf Oxford University Press Scientia