Mortality among ESKD patients with COVID-19: comparison between kidney transplant and hemodialysis

ABSTRACT

Background: The COVID-19 pandemic has had an impact on almost every aspect of human life. With more than 170 million cases and more than 3.5 million deaths worldwide (as of May 30, 2021), new facets of the fallout are being uncovered day after day. We analyzed the effects of COVID-19 on end stage kidney disease (ESKD) patients and compared the demographic profile and mortality in patients on hemodialysis (HD) to those who received kidney transplant (KT) in a large multicenter cohort. Methods: We performed a retrospective multi-center cohort study using TriNetX Research Network database, a federated electronic medical records network, to identify 3601 ESKD patients ≥ 18 years who had either received a kidney transplant (KT) (n=1849 from 34 healthcare organizations [HCOs]) or had been started on hemodialysis (HD) before 12/31/2019 (n=1752 from 31 HCOs) and who had been diagnosed with COVID-19 infection between 1/1/2020-12/31/2020. We used the KT group as the reference and calculated the comparative risk of 6-month mortality after COVID-19 infection for the HD group, reported as the odds ratio (OR) and 95% confidence interval (CI). Results: Compared with KT patients, HD patients were more likely to be older at the time of COVID-19 infection (57.4±14.5 vs. 53.3±13.8 years;p<0.0001), more likely to be African-American (<0.0001), diabetic (p<0.0001), hypertensive (p=0.0002), and with a history of coronary artery bypass graft (CABG) (0.0021). A total of 366 patients died within 6 months of diagnosis of COVID infection. After propensity matching, COVID-19 positive patients on HD had a higher odds of mortality (OR 1.48;CI 1.14, 1.90) compared with COVID-positive patients with a KT. Conclusions: Among ESKD patients who contracted COVID-19 infection during 2020, the patients on HD were more likely than patients who had received a KT to be African-American, to have a history of diabetes, hypertension and CABG. HD patients were more likely to die within 6 months of COVID diagnosis compared to patients who received a KT.