Outcomes of patients with COVID-19 on kidney replacement therapy: a comparison among modalities in England

Savino, Manuela; Santhakumaran, Shalini; Evans, Katharine M; Steenkamp, Retha; Benoy-Deeney, Fran; Medcalf, James F; Nitsch, Dorothea

BACKGROUND: Chronic kidney disease (CKD) is a recognised risk factor of poor outcomes from COVID-19. METHODS: This retrospective cohort study used the UK Renal Registry (UKRR) database of people on kidney replacement therapy (KRT) at the end of 2019 in England and who tested positive for SARS-CoV-2 between 01/03/2020 and 31/08/2020, to analyse incidence and outcomes of COVID-19 among different KRT modalities. Comparisons with 2015-2019 mortality data were used to estimate excess deaths. RESULTS: 2,783 individuals on KRT tested positive for SARS-CoV-2. Patients from more deprived areas (most deprived vs least deprived HR 1.20, 95% CI 1.04-1.39) and those with diabetes compared to those without (HR 1.51, 95% CI 1.39-1.64) were more likely to test positive. Approximately 25% of in-centre haemodialysis and transplanted patients died within 28 days of testing positive, compared to 36% of those on home therapies. Mortality was higher in those aged ≥80 years compared to those aged 60-79 years (OR 1.71, 95% CI 1.34-2.19) and much lower in those listed for transplantation compared to those not listed (OR 0.56, 95% CI 0.40-0.80). Overall, excess mortality in 2020 for people on KRT was 36% higher than the 2015-2019 average. Excess deaths peaked in April 2020 at the height of the pandemic and were characterised by wide ethnic and regional disparities. CONCLUSIONS: The impact of COVID-19 on the English KRT population highlights their extreme vulnerability and emphasises the need to protect and prioritise this group for vaccination. COVID-19 has widened underlying inequalities in people with kidney disease making interventions that address health inequalities a priority.