COVID-19 相关死亡率在肾移植和透析患者：ERACODA 合作的结果。
COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration.
机构信息
Department of Nephrology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands.
Department of Health Evidence, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands.
出版信息
Nephrol Dial Transplant. 2020 Nov 1;35(11):1973-1983. doi: 10.1093/ndt/gfaa261.
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.
背景
接受肾脏替代治疗的患者属于弱势群体，他们可能因 2019 年冠状病毒病（COVID-19）而面临更高的死亡风险。目前，有关该患者人群的结局仅有有限的数据。
方法
我们建立了 ERACODA（欧洲肾脏协会 COVID-19 数据库）数据库，该数据库专门用于前瞻性地收集有关 COVID-19 肾移植和透析患者的详细数据。在此分析中，纳入了在 2020 年 2 月 1 日至 5 月 1 日期间就诊且主要结局参数（28 天死亡率）信息完整的患者。
结果
在纳入的 1073 例患者中，305 例（28%）为肾移植患者，768 例（72%）为透析患者，平均年龄分别为 60±13 岁和 67±14 岁。肾移植患者 28 天死亡率为 21.3%[95%置信区间（95%CI）14.3%30.2%]，透析患者为 25.0%（95%CI 20.2%30.0%）。在肾移植患者中，死亡的主要相关因素是高龄，在透析患者中则是高龄和虚弱。在校正性别、年龄和虚弱程度后，移植患者与透析患者的院内死亡率无显著差异[风险比（HR）0.81，95%CI 0.591.10，P=0.18]。在适合移植的透析患者亚组（n=148）中，28 天内有 8 例死亡，而在就诊前 1 年内接受肾脏移植的 23 例患者中仅有 7 例死亡（校正性别、年龄和虚弱程度后的 HR 0.20，95%CI 0.070.56，P<0.01）。
结论
COVID-19 合并肾脏替代治疗的患者 28 天病死率较高，主要由年龄和虚弱等危险因素驱动。此外，与等待移植的透析患者相比，在肾脏移植后 1 年内，患者可能面临更高的 COVID-19 相关死亡风险。这些信息对于指导临床决策以及向公众和卫生保健部门通报肾移植和透析患者的 COVID-19 相关死亡风险非常重要。
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