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Incidence, characteristics, and outcome of COVID-19 in adults on kidney replacement therapy : a regionwide registry study

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Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial. Methods: To describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19). Results: At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015-2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection. Conclusions: Mortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic's overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.
Keywords
hemodialysis, kidney transplantation, clinical epidemiology, mortality, virology, COVID-19

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MLA
De Meester, Johan, et al. “Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy : A Regionwide Registry Study.” JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, vol. 32, no. 2, 2021, pp. 385–96, doi:10.1681/ASN.2020060875.
APA
De Meester, J., De Bacquer, D., Naessens, M., Meijers, B., Couttenye, M. M., De Vriese, A., … on behalf of NBVN Kidney Registry Group, [ missing ]. (2021). Incidence, characteristics, and outcome of COVID-19 in adults on kidney replacement therapy : a regionwide registry study. JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 32(2), 385–396. https://doi.org/10.1681/ASN.2020060875
Chicago author-date
De Meester, Johan, Dirk De Bacquer, Maarten Naessens, Bjorn Meijers, Marie M. Couttenye, An De Vriese, Wim Van Biesen, and [ missing ] on behalf of NBVN Kidney Registry Group. 2021. “Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy : A Regionwide Registry Study.” JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 32 (2): 385–96. https://doi.org/10.1681/ASN.2020060875.
Chicago author-date (all authors)
De Meester, Johan, Dirk De Bacquer, Maarten Naessens, Bjorn Meijers, Marie M. Couttenye, An De Vriese, Wim Van Biesen, and [ missing ] on behalf of NBVN Kidney Registry Group. 2021. “Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy : A Regionwide Registry Study.” JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 32 (2): 385–396. doi:10.1681/ASN.2020060875.
Vancouver
1.
De Meester J, De Bacquer D, Naessens M, Meijers B, Couttenye MM, De Vriese A, et al. Incidence, characteristics, and outcome of COVID-19 in adults on kidney replacement therapy : a regionwide registry study. JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY. 2021;32(2):385–96.
IEEE
[1]
J. De Meester et al., “Incidence, characteristics, and outcome of COVID-19 in adults on kidney replacement therapy : a regionwide registry study,” JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, vol. 32, no. 2, pp. 385–396, 2021.
@article{8691285,
  abstract     = {{Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial.

Methods: To describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19).

Results: At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015-2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection.

Conclusions: Mortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic's overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.}},
  author       = {{De Meester, Johan and De Bacquer, Dirk and Naessens, Maarten and Meijers, Bjorn and Couttenye, Marie M. and De Vriese, An and Van Biesen, Wim and on behalf of NBVN Kidney Registry Group, [ missing ]}},
  issn         = {{1046-6673}},
  journal      = {{JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY}},
  keywords     = {{hemodialysis,kidney transplantation,clinical epidemiology,mortality,virology,COVID-19}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{385--396}},
  title        = {{Incidence, characteristics, and outcome of COVID-19 in adults on kidney replacement therapy : a regionwide registry study}},
  url          = {{http://dx.doi.org/10.1681/ASN.2020060875}},
  volume       = {{32}},
  year         = {{2021}},
}

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