RT Journal Article
T1 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.
A1 Quiroga, Borja
A1 Ortiz, Alberto
A1 Cabezas-Reina, Carlos Jesus
A1 Ruiz Fuentes, Maria Carmen
A1 Lopez Jimenez, Veronica
A1 Zarraga Larrondo, Sofia
A1 Toapanta, Nestor
A1 Molina Gomez, Maria
A1 de Sequera, Patricia
A1 Sanchez-Alvarez, Emilio
A1 Spanish COVID-19 KRT Registry collaborative group, 
K1 COVID-19
K1 SARS-CoV-2
K1 dialysis
K1 kidney transplant
K1 mortality
AB 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 The clinical presentation and outcomes of COVID-19 during the first wave no longer represent COVID-19 in KRT patients, as the pandemic has become centred around vaccinated KT recipients.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.
PB Oxford University Press
SN 2048-8505
YR 2022
FD 2022-06-03
LK http://hdl.handle.net/10668/19751
UL http://hdl.handle.net/10668/19751
LA en
NO Quiroga B, Ortiz A, Cabezas-Reina CJ, Ruiz Fuentes MC, López Jiménez V, Zárraga Larrondo S, Toapanta N, Molina Gómez M, de Sequera P, Sánchez-Álvarez E; Spanish COVID-19 KRT Registry collaborative group. 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 Jun 3;15(9):1685-1697
NO 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, ERAPerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071, ISCIII-RETIC REDinREN RD016/0009)], Sociedad Española de Nefrología, FRIAT,  omunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. Instituto de Salud Carlos III (ISCIII) RICORS program to RICORS2040 (RD21/0005/0001), FEDER funds.
DS RISalud
RD Apr 7, 2025