COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration

ERACODA Collaborators, Luuk B Hilbrands, Raphaël Duivenvoorden, Priya Vart, Casper F M Franssen, Marc H Hemmelder, Kitty J Jager, Lyanne M Kieneker, Marlies Noordzij, Michelle J Pena, Hanne de Vries, David Arroyo, Adrian Covic, Marta Crespo, Eric Goffin, Mahmud Islam, Ziad A Massy, Nuria Montero, João P Oliveira, Ana Roca MuñozJ Emilio Sanchez, Sivakumar Sridharan, Rebecca Winzeler, Ron T Gansevoort

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BACKGROUND: Patients on kidney replacement therapy comprise a vulnerable population and may be at increased risk of death from coronavirus disease 2019 (COVID-19). Currently, only limited data are available on outcomes in this patient population.

METHODS: We set up the ERACODA (European Renal Association COVID-19 Database) database, which is specifically designed to prospectively collect detailed data on kidney transplant and dialysis patients with COVID-19. For this analysis, patients were included who presented between 1 February and 1 May 2020 and had complete information available on the primary outcome parameter, 28-day mortality.

RESULTS: Of the 1073 patients enrolled, 305 (28%) were kidney transplant and 768 (72%) dialysis patients with a mean age of 60 ± 13 and 67 ± 14 years, respectively. The 28-day probability of death was 21.3% [95% confidence interval (95% CI) 14.3-30.2%] in kidney transplant and 25.0% (95% CI 20.2-30.0%) in dialysis patients. Mortality was primarily associated with advanced age in kidney transplant patients, and with age and frailty in dialysis patients. After adjusting for sex, age and frailty, in-hospital mortality did not significantly differ between transplant and dialysis patients [hazard ratio (HR) 0.81, 95% CI 0.59-1.10, P = 0.18]. In the subset of dialysis patients who were a candidate for transplantation (n = 148), 8 patients died within 28 days, as compared with 7 deaths in 23 patients who underwent a kidney transplantation <1 year before presentation (HR adjusted for sex, age and frailty 0.20, 95% CI 0.07-0.56, P < 0.01).

CONCLUSIONS: The 28-day case-fatality rate is high in patients on kidney replacement therapy with COVID-19 and is primarily driven by the risk factors age and frailty. Furthermore, in the first year after kidney transplantation, patients may be at increased risk of COVID-19-related mortality as compared with dialysis patients on the waiting list for transplantation. This information is important in guiding clinical decision-making, and for informing the public and healthcare authorities on the COVID-19-related mortality risk in kidney transplant and dialysis patients.

Original languageEnglish
Pages (from-to)1973-1983
Number of pages11
JournalNephrology, Dialysis, Transplantation
Issue number11
Publication statusPublished - 1-Nov-2020


  • COVID-19
  • dialysis
  • kidney
  • mortality
  • transplantation

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