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Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients

Chronic renal replacement therapy by either a kidney transplant (KTX) or hemodialysis (HD) predisposes patients to an increased risk for adverse outcomes of COVID-19. However, details on this interaction remain incomplete. To provide further characterization, we undertook a retrospective observation...

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Autores principales: Villa, Luigi, Krüger, Thilo, Seikrit, Claudia, Mühlfeld, Anja S., Kunter, Uta, Werner, Cornelius, Kleines, Michael, Schulze-Hagen, Maximilian, Dreher, Michael, Kersten, Alexander, Marx, Nikolaus, Floege, Jürgen, Rauen, Thomas, Braun, Gerald S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969209/
https://www.ncbi.nlm.nih.gov/pubmed/33725847
http://dx.doi.org/10.1097/MD.0000000000024893
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author Villa, Luigi
Krüger, Thilo
Seikrit, Claudia
Mühlfeld, Anja S.
Kunter, Uta
Werner, Cornelius
Kleines, Michael
Schulze-Hagen, Maximilian
Dreher, Michael
Kersten, Alexander
Marx, Nikolaus
Floege, Jürgen
Rauen, Thomas
Braun, Gerald S.
author_facet Villa, Luigi
Krüger, Thilo
Seikrit, Claudia
Mühlfeld, Anja S.
Kunter, Uta
Werner, Cornelius
Kleines, Michael
Schulze-Hagen, Maximilian
Dreher, Michael
Kersten, Alexander
Marx, Nikolaus
Floege, Jürgen
Rauen, Thomas
Braun, Gerald S.
author_sort Villa, Luigi
collection PubMed
description Chronic renal replacement therapy by either a kidney transplant (KTX) or hemodialysis (HD) predisposes patients to an increased risk for adverse outcomes of COVID-19. However, details on this interaction remain incomplete. To provide further characterization, we undertook a retrospective observational cohort analysis of the majority of the hemodialysis and renal transplant population affected by the first regional outbreak of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) in Germany. In a region of 250,000 inhabitants we identified a total of 21 cases with SARS-CoV-2 among 100 KTX and 260 HD patients, that is, 7 KTX with COVID-19, 14 HD with COVID-19, and 3 HD with asymptomatic carrier status. As a first observation, KTX recipients exhibited trends for a higher mortality (43 vs 18%) and a higher proportion of acute respiratory distress syndrome (ARDS) (57 vs 27%) when compared to their HD counterparts. As a novel finding, development of ARDS was significantly associated with the time spent on previous renal replacement therapy (RRT), defined as the composite of dialysis time and time on the transplant (non-ARDS 4.3 vs ARDS 10.6 years, P = .016). Multivariate logistic regression analysis showed an OR of 1.7 per year of RRT. The association remained robust when analysis was confined to KTX patients (5.1 vs 13.2 years, P = .002) or when correlating the time spent on a renal transplant alone (P = .038). Similarly, longer RRT correlated with death vs survival (P = .0002). In conclusion our data suggest renal replacement vintage as a novel risk factor for COVID-19-associated ARDS and death. The findings should be validated by larger cohorts.
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spelling pubmed-79692092021-03-18 Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients Villa, Luigi Krüger, Thilo Seikrit, Claudia Mühlfeld, Anja S. Kunter, Uta Werner, Cornelius Kleines, Michael Schulze-Hagen, Maximilian Dreher, Michael Kersten, Alexander Marx, Nikolaus Floege, Jürgen Rauen, Thomas Braun, Gerald S. Medicine (Baltimore) 5200 Chronic renal replacement therapy by either a kidney transplant (KTX) or hemodialysis (HD) predisposes patients to an increased risk for adverse outcomes of COVID-19. However, details on this interaction remain incomplete. To provide further characterization, we undertook a retrospective observational cohort analysis of the majority of the hemodialysis and renal transplant population affected by the first regional outbreak of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) in Germany. In a region of 250,000 inhabitants we identified a total of 21 cases with SARS-CoV-2 among 100 KTX and 260 HD patients, that is, 7 KTX with COVID-19, 14 HD with COVID-19, and 3 HD with asymptomatic carrier status. As a first observation, KTX recipients exhibited trends for a higher mortality (43 vs 18%) and a higher proportion of acute respiratory distress syndrome (ARDS) (57 vs 27%) when compared to their HD counterparts. As a novel finding, development of ARDS was significantly associated with the time spent on previous renal replacement therapy (RRT), defined as the composite of dialysis time and time on the transplant (non-ARDS 4.3 vs ARDS 10.6 years, P = .016). Multivariate logistic regression analysis showed an OR of 1.7 per year of RRT. The association remained robust when analysis was confined to KTX patients (5.1 vs 13.2 years, P = .002) or when correlating the time spent on a renal transplant alone (P = .038). Similarly, longer RRT correlated with death vs survival (P = .0002). In conclusion our data suggest renal replacement vintage as a novel risk factor for COVID-19-associated ARDS and death. The findings should be validated by larger cohorts. Lippincott Williams & Wilkins 2021-03-12 /pmc/articles/PMC7969209/ /pubmed/33725847 http://dx.doi.org/10.1097/MD.0000000000024893 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle 5200
Villa, Luigi
Krüger, Thilo
Seikrit, Claudia
Mühlfeld, Anja S.
Kunter, Uta
Werner, Cornelius
Kleines, Michael
Schulze-Hagen, Maximilian
Dreher, Michael
Kersten, Alexander
Marx, Nikolaus
Floege, Jürgen
Rauen, Thomas
Braun, Gerald S.
Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients
title Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients
title_full Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients
title_fullStr Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients
title_full_unstemmed Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients
title_short Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients
title_sort time on previous renal replacement therapy is associated with worse outcomes of covid-19 in a regional cohort of kidney transplant and dialysis patients
topic 5200
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969209/
https://www.ncbi.nlm.nih.gov/pubmed/33725847
http://dx.doi.org/10.1097/MD.0000000000024893
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