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1. Recovery of dialysis patients with COVID-19: health outcomes 3 months after diagnosis in ERACODA

Author

Hemmelder, Marc H, Noordzij, Marlies, Vart, Priya, Hilbrands, Luuk B, Jager, Kitty J, Abrahams, Alferso C, Arroyo, David, Battaglia, Yuri, Ekart, Robert, Mallamaci, Francesca, Malloney, Sharon-Rose, Oliveira, Joao, Rydzewski, Andrzej, Sridharan, Sivakumar, Vogt, Liffert, Duivenvoorden, Raphaël, Gansevoort, Ron T, Franssen, Casper FM, van der Net, Jeroen B, Essig, Marie, du Buf-Vereijken, Peggy WG, van Ginneken, Betty, Maas, Nanda, van Jaarsveld, Brigit C, Bemelman, Frederike J, Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G, Nurmohamed, Azam, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M, Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Konings, Constantijn JAM, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Alferes, Daniela G, Radulescu, Daniela, Zakharova, Elena V, Ambuehl, Patrice Max, Guidotti, Rebecca, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, Katicic, Dajana, Dam, Marc ten, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L, Logtenberg, Susan JJ, Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen JP, ElHafeez, Samar Abd, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies EJ, Hesselink, Dennis A, van Gestel, J Kal-, Eiselt, Jaromir, Kielberger, Lukas, El-Wakil, Hala S, Verhoeven, Martine AM, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M, Debska-Slizien, Alicja, Veldhuizen, Nicoline MH, Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Nistor, Ionut, Covic, Adrian, Groeneveld, JHM, Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Pereira, Tiago Assis, and dos Santos, Augusto Cesar Soares

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Kidney Disease, Patient Safety, Clinical Research, 4.1 Discovery and preclinical testing of markers and technologies, Detection, screening and diagnosis, Good Health and Well Being, Aged, Aged, 80 and over, COVID-19, COVID-19 Testing, Female, Humans, Intensive Care Units, Male, Middle Aged, Outcome Assessment, Health Care, Renal Dialysis, SARS-CoV-2, ERACODA Collaborators, dialysis, functional health status, mental health status, survival, Urology & Nephrology, Clinical sciences
Abstract

BackgroundCoronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis.MethodsWe analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression.ResultsIn 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8-6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome.ConclusionsMortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis.

Published
2022

2. Clinical triage of patients on kidney replacement therapy presenting with COVID-19: an ERACODA registry analysis

Author

Mitra, Sandip, Jayanti, Anuradha, Vart, Priya, Coca, Armando, Gallieni, Maurizio, Øvrehus, Marius Altern, Midtvedt, Karsten, Abd ElHafeez, Samar, Gandolfini, Iliaria, Büttner, Stefan, Franssen, Casper FM, Hemmelder, Marc H, van der Net, Jeroen B, Essig, Marie, du Buf-Vereijken, Peggy WG, van Ginneken, Betty, Vogt, Nanda Maas Liffert, van Jaarsveld, Brigit C, Jager, Kitty J, Bemelman, Frederike J, Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G, Nurmohamed, Azam, Abramowicz, Daniel, Maoujoud, Sabine Verhofstede Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M, Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Rydzewski, rzej, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G, Zakharova, Elena V, Ambuehl, Patrice Max, Walker, rea, Winzeler, Rebecca, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Katicic, Dajana, Dam, Marc ten, Krüger, Thilo, Brzosko, Szymon, Zanen, Adriaan L, Logtenberg, Susan JJ, Fricke, Lutz, Slebe, Jeroen JP, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies EJ, Eiselt, Jaromir, Kielberger, Lukas, El-Wakil, Hala S, Verhoeven, Martine AM, Canal, Cristina, Facundo, Carme, Ramos, Ana M, Debska-Slizien, Alicja, Veldhuizen, Nicoline MH, Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Covic, Adrian, Matceac, Irina, Nistor, Ionut, Cordos, Monica, Groeneveld, JHM, van Buren, Jolanda Jousma Marjolijn, Pereira, Fritz Diekmann Tiago Assis, Santos, Augusto Cesar S, Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Hofstra, Julia M, Franco, Antonio, Arroyo, David, Rodríguez-Ferrero, Maria Luisa, Manzanos, Sagrario Balda, Haridian Sosa Barrios, R, Ávila, Gonçalo, Laranjinha, Ivo, Mateus, Catarina, and Lemahieu, Wim

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Transplantation, Clinical Research, Kidney Disease, Prevention, Renal and urogenital, Good Health and Well Being, Aged, COVID-19, Hospitalization, Humans, Oxygen Saturation, Registries, Renal Replacement Therapy, SARS-CoV-2, Triage, dialysis, kidney, mortality, second presentation, transplantation, ERACODA Collaborators, Urology & Nephrology, Clinical sciences
Abstract

BackgroundPatients on kidney replacement therapy (KRT) are at very high risk of coronavirus disease 2019 (COVID-19). The triage pathway for KRT patients presenting to hospitals with varying severity of COVID-19 illness remains ill-defined. We studied the clinical characteristics of patients at initial and subsequent hospital presentations and the impact on patient outcomes.MethodsThe European Renal Association COVID-19 Database (ERACODA) was analysed for clinical and laboratory features of 1423 KRT patients with COVID-19 either hospitalized or non-hospitalized at initial triage and those re-presenting a second time. Predictors of outcomes (hospitalization, 28-day mortality) were then determined for all those not hospitalized at initial triage.ResultsAmong 1423 KRT patients with COVID-19 [haemodialysis (HD), n = 1017; transplant, n = 406), 25% (n = 355) were not hospitalized at first presentation due to mild illness (30% HD, 13% transplant). Of the non-hospitalized patients, only 10% (n = 36) re-presented a second time, with a 5-day median interval between the two presentations (interquartile range 2-7 days). Patients who re-presented had worsening respiratory symptoms, a decrease in oxygen saturation (97% versus 90%) and an increase in C-reactive protein (26 versus 73 mg/L) and were older (72 vs 63 years) compared with those who did not return a second time. The 28-day mortality between early admission (at first presentation) and deferred admission (at second presentation) was not significantly different (29% versus 25%; P = 0.6). Older age, prior smoking history, higher clinical frailty score and self-reported shortness of breath at first presentation were identified as risk predictors of mortality when re-presenting after discharge at initial triage.ConclusionsThis study provides evidence that KRT patients with COVID-19 and mild illness can be managed effectively with supported outpatient care and with vigilance of respiratory symptoms, especially in those with risk factors for poor outcomes. Our findings support a risk-stratified clinical approach to admissions and discharges of KRT patients presenting with COVID-19 to aid clinical triage and optimize resource utilization during the ongoing pandemic.

Published
2021

3. COVID-19-related mortality in kidney transplant and haemodialysis patients

Author

Goffin, Eric, Candellier, Alexandre, Vart, Priya, Noordzij, Marlies, Arnol, Miha, Covic, Adrian, Lentini, Paolo, Malik, Shafi, Reichert, Louis J., Sever, Mehmet S., Watschinger, Bruno, Jager, Kitty J., Gansevoort, Ron T., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Vogt, Liffert, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Avitum, B. Braun, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Rydzewski, Andrzej, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Zakharova, Elena V., Ambuehl, Patrice Max, Walker, Andrea, Winzeler, Rebecca, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Slebe, Jeroen J. P., Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Eiselt, Jaromir, Kielberger, Lukas, el-Wakil, Hala S., Verhoeven, Martine A. M., Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Matceac, Irina, Nistor, Ionut, Cordos, Monica, Groeneveld, J. H. M., Jousma, Jolanda, van Buren, Marjolijn, Elhafeez, Samar Abd, Diekmann, Fritz, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Hofstra, Julia M., Franco, Antonio, Arroyo, David, Rodríguez-Ferrero, Maria Luisa, Manzanos, Sagrario Balda, Barrios, R. Haridian Sosa, Ávila, Gonçalo, Laranjinha, Ivo, Mateus, Catarina, Lemahieu, Wim, Dirim, Ahmet Burak, Demir, Erol, Å afak, Seda, Turkmen, Aydin, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Hemmelder, Marc, Kumar, Mohan N., di Luca, Marina, Tuǧlular, Serhan Z., Kramer, Andrea, Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Adema, Aaltje Y., Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Duivenvoorden, Raphaël, Hilbrands, Luuk, Kerckhoffs, Angele, Maas, Rutger, Lebedeva, Olga, Lopez, Veronica, Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, Meijers, Björn K. I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnelier, Annelies, Wissing, Karl M., de Arriba, Gabriel, Dedinska, Ivana, Pessolano, Giuseppina, Gandolfini, Ilaria, Maggiore, Umberto, Papachristou, Evangelos, Franssen, Casper F. M., Berger, Stefan P., Meijer, Esther, Özyilmaz, Akin, Sanders, Jan Stephan F., Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamos, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Sabiu, Gianmarco, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimsevicius, Laurynas, Righetti, Marco, Islam, Mahmud, Braak, Nicole Heitink-Ter, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Internal Medicine, Clinical sciences, Nephrology, ACS - Diabetes & metabolism, AII - Inflammatory diseases, AII - Infectious diseases, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Quality of Care, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, and APH - Global Health

Subjects
medicine.medical_specialty, kidney, Original Article - Dialysis, medicine.medical_treatment, infectious diseases, law.invention, Kidney Failure, SDG 3 - Good Health and Well-being, Renal Dialysis, Risk Factors, law, Internal medicine, medicine, Humans, COVID-19, dialysis, mortality, transplantation, Registries, Renal replacement therapy, Chronic, AcademicSubjects/MED00340, Kidney transplantation, Dialysis, Transplantation, SARS-CoV-2, business.industry, Kidney Transplantation/adverse effects, Hazard ratio, medicine.disease, Kidney Transplantation, Intensive care unit, Comorbidity, Transplant Recipients, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Kidney Failure, Chronic/therapy, Nephrology, Kidney Failure, Chronic, Hemodialysis, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business
Abstract

BACKGROUND AND AIMS: Studies examining kidney failure patients with COVID-19 reported higher mortality in hemodialysis patients than in kidney transplant recipients. However, hemodialysis patients are often older and have more comorbidities. This study investigated the association of type of kidney replacement therapy with COVID-19 severity adjusting for differences in characteristics. METHOD: Data were retrieved from the European Renal Association COVID-19 Database (ERACODA), which includes kidney replacement therapy patients diagnosed with COVID-19 from all over Europe. We included all kidney transplant recipients and hemodialysis patients who presented between February 1st and December 1st 2020 and had complete information reason for COVID-19 screening and vital status at day 28. The diagnosis of COVID-19 was made based on a PCR of a nasal or pharyngeal swab specimens and/or COVID-19 compatible findings on a lung CT scan. The association of kidney transplantation or hemodialysis with 28-day mortality was examined using Cox proportional-hazards regression models adjusted for age, sex, frailty and comorbidities. Additionally, this association was investigated in the subsets of patients that were screened because of symptoms or have had routine screening. RESULTS: A total of 1,670 patients (496 functional kidney transplant recipients and 1,174 hemodialysis patients) were examined. 16.9% of kidney transplant recipients and 23.9% of hemodialysis patients died within 28 days of presentation. In an unadjusted model, the risk of 28-day mortality was 33% lower in kidney transplant recipients compared with hemodialysis patients (hazard ratio (HR): 0.67, 95% CI: 0.52, 0.85). However, in an age, sex and frailty adjusted model, the risk of 28-day mortality was 29% higher in kidney transplant recipients (HR=1.29, 95% CI: 1.00, 1.68), whereas in a fully adjusted model the risk was even 43% higher (HR=1.43, 95% CI: 1.06, 1.93). This association in patients who were screened because of symptoms (n=1,145) was similar (fully adjusted model HR=1.46, 95% CI: 1.05, 2.04). Results were similar when other endpoints were studied (e.g. risk for hospitalization, ICU admission or mortality beyond 28 days) as well as across subgroups. Only age was found to interact significantly, suggesting that the increased mortality risk associated with kidney transplantation was especially present in elderly subjects. CONCLUSION: In this study, kidney transplant recipients had a greater risk of a more severe course of COVID-19 compared with hemodialysis patients when adjusted for age, sex and comorbidities.

Published
2021
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4. Sex differences in COVID-19 mortality risk in patients on kidney function replacement therapy

Author

Vart, Priya, Duivenvoorden, Raphaël, Adema, Aaltje, Covic, Adrian, Finne, Patrik, Braak, Nicole Heijtink-ter, Laine, Kaisa, Noordzij, Marlies, Schouten, Marcel, Jager, Kitty J., Gansevoort, Ron T., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Maas, Nanda, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Vogt, Liffert, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Radulescu, Daniela, Hengst, Maaike, Konings, Constantijn, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Zakharova, Elena V., Ambühl, Patrice Max, Guidotti, Rebecca, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J. P., ElHafeez, Samar Abd, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Hesselink, Dennis A., Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, El-Wakil, Hala S., Verhoeven, Martine, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Nistor, Ionut, Groeneveld, J. H.M., Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M., Siezenga, Machiel A., Franco, Antonio, Arroyo, David, Castellano, Sandra, Rodríguez-Ferrero, Maria Luisa, Manzanos, Sagrario Balda, Barrios, R. Haridian Sosa, Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petrulienė, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Hemmelder, Marc H., MohanKumar, N., Di Luca, Marina, Tuğlular, Serhan Z., Kramer, Andrea B., Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, van de Logt, Anne Els, Maas, Rutger, Hilbrands, Luuk B., Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J. M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Sahin, İdris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K. I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P., Sanders, Jan Stephan F., Franssen, Casper F. M., Özyilmaz, Akin, Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamo, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Soler, Maria Jose, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimševičius, Laurynas, Righetti, Marco, Islam, Mahmud, Clinical sciences, Nephrology, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Groningen Institute for Organ Transplantation (GIOT), Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, AII - Inflammatory diseases, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, Internal Medicine, Department of Medicine, Clinicum, University of Helsinki, Helsinki University Hospital Area, ACS - Diabetes & metabolism, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, and UCL - (SLuc) Service de néphrologie

Subjects
Male, kidney, Transplant, infectious diseases, Kidney, All institutes and research themes of the Radboud University Medical Center, COVID‐19, Renal Dialysis, Risk Factors, risk factors, Humans, Eracoda, Aged, Sex Characteristics, Multidisciplinary, Dialysis patients, Kidney Transplantation/adverse effects, COVID-19, Middle Aged, Kidney Transplantation, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Nephrology, 3121 General medicine, internal medicine and other clinical medicine, mortality risk, Immunosuppressive Agents/therapeutic use, Female, Immunosuppressive Agents
Abstract

In the general population with COVID-19, the male sex is an established risk factor for mortality, in part due to a more robust immune response to COVID-19 in women. Because patients on kidney function replacement therapy (KFRT) have an impaired immune response, especially kidney transplant recipients due to their use of immunosuppressants, we examined whether the male sex is still a risk factor for mortality among patients on KFRT with COVID-19. From the European Renal Association COVID-19 Database (ERACODA), we examined patients on KFRT with COVID-19 who presented between February 1st, 2020, and April 30th, 2021. 1204 kidney transplant recipients (male 62.0%, mean age 56.4 years) and 3206 dialysis patients (male 61.8%, mean age 67.7 years) were examined. Three-month mortality in kidney transplant recipients was 16.9% in males and 18.6% in females (p = 0.31) and in dialysis patients 27.1% in males and 21.9% in females (p = 0.001). The adjusted HR for the risk of 3-month mortality in males (vs females) was 0.89 (95% CI 65, 1.23, p = 0.49) in kidney transplant recipients and 1.33 (95% CI 1.13, 1.56, p = 0.001) in dialysis patients (pinteraction = 0.02). In a fully adjusted model, the aHR for the risk of 3-month mortality in kidney transplant recipients (vs. dialysis patients) was 1.39 (95% CI 1.02, 1.89, p = 0.04) in males and 2.04 (95% CI 1.40, 2.97, p interaction = 0.02). In patients on KFRT with COVID-19, the male sex is not a risk factor for mortality among kidney transplant recipients but remains a risk factor among dialysis patients. The use of immunosuppressants in kidney transplant recipients, among other factors, may have narrowed the difference in the immune response to COVID-19 between men and women, and therefore reduced the sex difference in COVID-19 mortality risk.

Published
2022
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5. Clinical, Functional, and Mental Health Outcomes in Kidney Transplant Recipients 3 Months After a Diagnosis of COVID-19

Author

Duivenvoorden, Raphaël, Vart, Priya, Noordzij, Marlies, Soares Dos Santos, Augusto C., Zulkarnaev, Alex B., Franssen, Casper F. M., Kuypers, Dirk, Demir, Erol, Rahimzadeh, Hormat, Kerschbaum, Julia, Jager, Kitty J., Turkmen, Kultigin, Hemmelder, Marc H., Schouten, Marcel, Rodríguez-Ferrero, María Luisa, Crespo, Marta, Gansevoort, Ron T., Hilbrands, Luuk B., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Maas, Nanda, Vogt, Liffert, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Montero Perez, Nuria, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Konings, Constantijn, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Radulescu, Daniela, Zakharova, Elena V., Ambuehl, Patrice Max, Guidotti, Rebecca, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Strazmester Majstorovic, Gordana, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J. P., Abd Elhafeez, Samar, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Hesselink, Dennis A., Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, el-Wakil, Hala S., Verhoeven, Martine, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Polyzou Konsta, Maria Anna, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Nistor, Ionut, Covic, Adrian, Groeneveld, J. H. M., Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Assis Pereira, Tiago, Arias-Cabrales, Carlos, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M., Siezenga, Machiel A., Franco, Antonio, Arroyo, David, Castellano, Sandra, Balda Manzanos, Sagrario, Sosa Barrios, R. Haridian, Lemahieu, Wim, Bartelet, Karlijn, Burak Dirim, Ahmet, Sukru Sever, Mehmet, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Mohan Kumar, N., di Luca, Marina, Tuǧlular, Serhan Z., Kramer, Andrea, Beerenhout, Charles, Luik, Peter T., Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y., Stepanov, Vadim A., Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, van de Logt, Anne Els, Maas, Rutger, Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J. M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rychlik, Ivan, Cabezas-Reina, Carlos J., Maria Roca, Ana, Nauta, Ferdau, Sahin, İdris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K. I., Naesens, Maarten, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P., Meijer, Esther, Sanders, Jan Stephan F., Özyilmaz, Akin, Buturović Ponikvar, Jadranka, Marn Pernat, Andreja, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamo, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Jose Soler, Maria, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimsevicius, Laurynas, Righetti, Marco, Islam, Mahmud, Heitink-ter Braak, Nicole, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, Nephrology, ACS - Diabetes & metabolism, Internal Medicine, Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, and Clinical sciences

Subjects
kidney transplant, Adult, Kidney Disease, Outcome Assessment, Renal and urogenital, infectious diseases, Medical and Health Sciences, clinical, DISEASE, All institutes and research themes of the Radboud University Medical Center, Rare Diseases, SDG 3 - Good Health and Well-being, 7.1 Individual care needs, Clinical Research, Outcome Assessment, Health Care, Humans, Retrospective Studies, Transplantation, SARS-CoV-2, MORTALITY, Rehabilitation, COVID-19, mental health outcomes, survive, Organ Transplantation, Original Clinical Science—General, Middle Aged, SOLID-ORGAN TRANSPLANT, Kidney Transplantation, Transplant Recipients, DIALYSIS PATIENTS, Health Care, functional, Intensive Care Units, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Good Health and Well Being, Nephrology, ERACODA, ERACODA Collaborators, Surgery, Management of diseases and conditions, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

BACKGROUND: Kidney transplant patients are at high risk for coronavirus disease 2019 (COVID-19)-related mortality. However, limited data are available on longer-term clinical, functional, and mental health outcomes in patients who survive COVID-19.METHODS: We analyzed data from adult kidney transplant patients in the European Renal Association COVID-19 Database who presented with COVID-19 between February 1, 2020, and January 31, 2021.RESULTS: We included 912 patients with a mean age of 56.7 (±13.7) y. 26.4% were not hospitalized, 57.5% were hospitalized without need for intensive care unit (ICU) admission, and 16.1% were hospitalized and admitted to the ICU. At 3 mo follow-up survival was 82.3% overall, and 98.8%, 84.2%, and 49.0%, respectively, in each group. At 3 mo follow-up biopsy-proven acute rejection, need for renal replacement therapy, and graft failure occurred in the overall group in 0.8%, 2.6%, and 1.8% respectively, and in 2.1%, 10.6%, and 10.6% of ICU-admitted patients, respectively. Of the surviving patients, 83.3% and 94.4% reached their pre-COVID-19 physician-reported functional and mental health status, respectively, within 3 mo. Of patients who had not yet reached their prior functional and mental health status, their treating physicians expected that 79.6% and 80.0%, respectively, still would do so within the coming year. ICU admission was independently associated with a low likelihood to reach prior functional and mental health status.CONCLUSIONS: In kidney transplant recipients alive at 3-mo follow-up, clinical, physician-reported functional, and mental health recovery was good for both nonhospitalized and hospitalized patients. Recovery was, however, less favorable for patients who had been admitted to the ICU.

Published
2022
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6. Immune Response in Moderate to Critical Breakthrough COVID-19 Infection After mRNA Vaccination

Author

Paniskaki, Krystallenia, Anft, Moritz, Meister, Toni L., Marheinecke, Corinna, Pfaender, Stephanie, Skrzypczyk, Sarah, Seibert, Felix S., Thieme, Constantin J., Konik, Margarethe J., Dolff, Sebastian, Anastasiou, Olympia, Holzer, Bodo, Dittmer, Ulf, Queren, Christine, Fricke, Lutz, Rohn, Hana, Westhoff, Timm H., Witzke, Oliver, Stervbo, Ulrik, Roch, Toralf, and Babel, Nina

Subjects
Adult, CD4-Positive T-Lymphocytes, Male, COVID-19 Vaccines, Coronavirus M Proteins, mRNA, breakthrough infection, T cells, Antibody Affinity, Medizin, CD8-Positive T-Lymphocytes, Antibodies, Viral, vaccine, Coronavirus Nucleocapsid Proteins, Humans, neutralizing antibodies, BNT162 Vaccine, Aged, Aged, 80 and over, SARS-CoV-2, Vaccination, COVID-19, Middle Aged, Phosphoproteins, Antibodies, Neutralizing, Spike Glycoprotein, Coronavirus, Female, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit, 2019-nCoV Vaccine mRNA-1273
Abstract

SARS-CoV-2 variants of concern (VOCs) can trigger severe endemic waves and vaccine breakthrough infections (VBI). We analyzed the cellular and humoral immune response in 8 patients infected with the alpha variant, resulting in moderate to fatal COVID-19 disease manifestation, after double mRNA-based anti-SARS-CoV-2 vaccination. In contrast to the uninfected vaccinated control cohort, the diseased individuals had no detectable high-avidity spike (S)-reactive CD4+ and CD8+ T cells against the alpha variant and wild type (WT) at disease onset, whereas a robust CD4+ T-cell response against the N- and M-proteins was generated. Furthermore, a delayed alpha S-reactive high-avidity CD4+ T-cell response was mounted during disease progression. Compared to the vaccinated control donors, these patients also had lower neutralizing antibody titers against the alpha variant at disease onset. The delayed development of alpha S-specific cellular and humoral immunity upon VBI indicates reduced immunogenicity against the S-protein of the alpha VOC, while there was a higher and earlier N- and M-reactive T-cell response. Our findings do not undermine the current vaccination strategies but underline a potential need for the inclusion of VBI patients in alternative vaccination strategies and additional antigenic targets in next-generation SARS-CoV-2 vaccines. CA extern

Published
2022

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