Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study

• Published in: Journal of nephrology Vol. 35; no. 1; pp. 131 - 141
• Main Authors: de Sandes-Freitas, Tainá Veras, de Andrade, Luís Gustavo Modelli, Moura, Lucio Roberto Requião, Cristelli, Marina Pontello, Medina-Pestana, José Osmar, Lugon, Jocemir Ronaldo, Sesso, Ricardo
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.01.2022
• Subjects: Cohort Studies; COVID-19; COVID-19 Testing; Humans; Medicine; Medicine & Public Health; Nephrology; Original; Original Article; Propensity Score; Renal Dialysis - adverse effects; Retrospective Studies; SARS-CoV-2; Urology; COVID-19; Renal dialysis; Propensity score; Kidney transplantation
• ISSN: 1121-8428; 1724-6059
• DOI: 10.1007/s40620-021-01172-1

Background and objectives Patients undergoing kidney replacement therapies (KRTs) have a poor prognosis after Covid-19 infection. Few studies have compared the outcomes of such patients in the different KRT modalities. This study aimed to analyze the 30-day Covid-19-associated case-fatality rate of dialysis and kidney transplant patients. Methods Retrospective cohort study analyzing data from patients with confirmed Covid-19 between Mar/20 and Jan/21 included in two multicenter studies, the Brazilian Covid-19 Dialysis Study (Dialysis group, n  = 703) and the Covid-19-KT Brazilian Study (Transplant group, n  = 1907). To assess the risk factors for death, adjusted Cox hazards models were used. A sensitivity analysis was performed using a propensity score analysis to match the groups ( n  = 587 patients in each group). Results A higher percentage of transplant patients required hospitalization (68 vs. 51%, p  < 0.001), intensive care (37 vs. 30%, p  = 0.023), and invasive mechanical ventilation (28 vs. 22%, p  = 0.035). Multivariate analysis of the before-matching sample showed that subjects in the transplant group were at a lower death risk at baseline (HR 0.38 0.56 0.85 ). However, they showed higher risk over time (HR 1.03 1.06 1.09 ). Kaplan–Meier analysis after propensity score matching confirmed the inferior 30-day cumulative survival in the transplant recipients (83 vs. 78%, p  = 0.0014). Conclusion Both transplant and dialysis patients have high 30-day case-fatality rates after a Covid-19 diagnosis. Despite lower death risk at baseline, transplant patients have an increased death risk of 6% per day than dialysis patients. Graphical Abstract