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1. Adaptative Strategy of Immunosuppressive Drugs Dosage Adjustments When Combined With Nirmatrelvir/Ritonavir in Solid Organ Transplant Recipients With COVID-19.

Author

Boland L, Devresse A, Monchaud C, Briol S, Belaiche S, Giguet B, Couzi L, Thaunat O, Esposito L, Meszaros M, Roussoulieres A, Haufroid V, Le Meur Y, and Lemaitre F

Subjects
Humans, Tacrolimus, Cyclosporine therapeutic use, Ritonavir therapeutic use, Ritonavir pharmacology, Retrospective Studies, COVID-19 Drug Treatment, SARS-CoV-2, Immunosuppressive Agents, Calcineurin Inhibitors therapeutic use, Transplant Recipients, Antiviral Agents therapeutic use, COVID-19, Organ Transplantation, Lactams, Leucine, Nitriles, Proline
Abstract

Nirmatrelvir/ritonavir is a promising option for preventing severe COVID-19 in solid organ transplant recipients with SARS-CoV-2 infection. However, concerns have arisen regarding potential drug interactions with calcineurin inhibitors (CNI). This two-phase multicentre retrospective study, involving 113 patients on tacrolimus and 13 on cyclosporine A, aimed to assess the feasibility and outcomes of recommendations issued by The French societies of transplantation (SFT) and pharmacology (SFPT) for CNI management in this context. The study first evaluated adherence to recommendations, CNI exposure, and clinical outcomes. Notably, 96.5% of patients on tacrolimus adhered to the recommendations, maintaining stable tacrolimus trough concentrations (C 0 ) during nirmatrelvir/ritonavir treatment. After reintroduction, most patients experienced increased C 0 , with 42.9% surpassing 15 ng/mL, including three patients exceeding 40 ng/mL. Similar trends were observed in cyclosporine A patients, with no COVID-19-related hospitalizations. Moreover, data from 22 patients were used to refine the reintroduction strategy. Modelling analyses suggested reintroducing tacrolimus at 50% of the initial dose on day 8, and then at 100% from day 9 as the optimal approach. In conclusion, the current strategy effectively maintains consistent tacrolimus exposure during nirmatrelvir/ritonavir treatment, and a stepwise reintroduction of tacrolimus may be better suited to the low CYP3A recovery., Competing Interests: AD reports consultancy fees from Alnylam and Merck outside the submitted work. CM reports research grants (paid to institution), financial support for participation in congresses, and expertise fees from Chiesi and Astellas. StB received lecture fees from Astellas. BG reports financial support for participation in congresses from Chiesi and Gilead, speaker for Gilead, outside the submitted work. LC received lecture fees from Astellas, Chiesi, Novartis, Sandoz, Ostuka, GSK, and Biotest, and participated in advisory boards for Biotest, Hansa, and Novartis. LE received fees from Astellas, Chiesi, and Sandoz. FL received research grants (paid to institution) from Astellas, Sandoz, and Chiesi and fees to attend meetings from Viiv, MSD, Janssen-Cilag, Pfizer, and Gilead. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Boland, Devresse, Monchaud, Briol, Belaiche, Giguet, Couzi, Thaunat, Esposito, Meszaros, Roussoulieres, Haufroid, Le Meur and Lemaitre.)

Published
2024
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4. Rapid Decline in Vaccine-induced Anti-SARS-CoV-2 Antibody Titers 3 Months After Kidney Transplantation: A Case Series From Belgium.

Author

Fernandes G, Devresse A, Scohy A, Yombi JC, Belkhir L, De Greef J, De Meyer M, Mourad M, Darius T, Buemi A, Kabamba B, Goffin E, and Kanaan N

Subjects
Antibodies, Viral, Belgium, Humans, SARS-CoV-2, COVID-19, Kidney Transplantation adverse effects, Vaccines
Abstract

Competing Interests: The authors declare no funding or conflicts of interest.

Published
2022
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6. Better late than never: eventual seroconversion against SARS-CoV-2 in a kidney transplant recipient after repeated immune challenge and monoclonal antibody therapy.

Author

De Greef J, Devresse A, Saad Albichr I, Scohy A, Kanaan N, Georgery H, Belkhir L, Kabamba B, Yombi JC, and Goffin E

Subjects
Antibodies, Monoclonal therapeutic use, Antibodies, Viral, Humans, SARS-CoV-2 immunology, Transplant Recipients, COVID-19 immunology, Kidney Transplantation, Seroconversion
Published
2021
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7. Impact of Kidney Transplantation on Humoral Immunity Against SARS-CoV-2: A Case Series From Belgium.

Author

Fernandes G, Devresse A, Scohy A, Yombi JC, Belkhir L, De Greef J, De Meyer M, Mourad M, Darius T, Buemi A, Kabamba B, Goffin E, and Kanaan N

Subjects
Adult, Aged, Antibodies, Viral blood, Antibodies, Viral immunology, BNT162 Vaccine, Belgium, COVID-19 blood, COVID-19 prevention & control, COVID-19 virology, COVID-19 Vaccines administration & dosage, ChAdOx1 nCoV-19, Female, Graft Rejection immunology, Graft Rejection prevention & control, Humans, Male, Middle Aged, COVID-19 immunology, Immunity, Humoral drug effects, Immunosuppressive Agents adverse effects, Kidney Transplantation adverse effects, SARS-CoV-2 immunology
Published
2021
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8. Very Low Immunization Rate in Kidney Transplant Recipients After One Dose of the BNT162b2 Vaccine: Beware not to Lower the Guard!

Author

Georgery H, Devresse A, Yombi JC, Belkhir L, De Greef J, Darius T, Buemi A, Scohy A, Kabamba B, Goffin E, and Kanaan N

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, BNT162 Vaccine, COVID-19 immunology, COVID-19 virology, Female, Humans, Immunization Schedule, Immunocompromised Host, Immunosuppressive Agents adverse effects, Male, Middle Aged, SARS-CoV-2 pathogenicity, Time Factors, Young Adult, Antibodies, Viral blood, COVID-19 prevention & control, COVID-19 Vaccines administration & dosage, Immunogenicity, Vaccine, Kidney Transplantation adverse effects, SARS-CoV-2 immunology, Spike Glycoprotein, Coronavirus immunology, Vaccination
Abstract

Competing Interests: The authors declare no funding or conflicts of interest.

Published
2021
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9. T-cell and Antibody Response After 2 Doses of the BNT162b2 Vaccine in a Belgian Cohort of Kidney Transplant Recipients.

Author

Devresse A, Saad Albichr I, Georgery H, Yombi JC, De Greef J, Belkhir L, Mzougui S, Scohy A, Darius T, Buemi A, Goffin E, Kabamba B, and Kanaan N

Subjects
Adult, Aged, BNT162 Vaccine, Belgium, COVID-19 immunology, COVID-19 virology, Female, Humans, Immunity, Humoral drug effects, Immunization Schedule, Immunocompromised Host, Immunosuppressive Agents adverse effects, Interferon-gamma metabolism, Lymphocyte Activation drug effects, Male, Middle Aged, Prospective Studies, SARS-CoV-2 pathogenicity, T-Lymphocytes immunology, T-Lymphocytes metabolism, T-Lymphocytes virology, Time Factors, Antibodies, Viral blood, COVID-19 prevention & control, COVID-19 Vaccines administration & dosage, Immunogenicity, Vaccine, Kidney Transplantation adverse effects, SARS-CoV-2 immunology, Spike Glycoprotein, Coronavirus immunology, T-Lymphocytes drug effects, Vaccination
Abstract

Competing Interests: The authors declare no funding or conflicts of interest.

Published
2021
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11. The Second Wave of COVID-19 Disease in a Kidney Transplant Recipient Cohort: A Single-center Experience in Belgium.

Author

Georgery H, Devresse A, Scohy A, Kabamba B, Darius T, Buemi A, De Greef J, Belkhir L, Yombi JC, Goffin E, and Kanaan N

Subjects
Adult, Aged, Aged, 80 and over, Belgium epidemiology, COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 therapy, COVID-19 Testing, Combined Modality Therapy, Cost of Illness, Female, Hospitalization, Humans, Male, Middle Aged, COVID-19 etiology, Kidney Transplantation, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications therapy
Abstract

Competing Interests: The other authors declare no funding or conflicts of interest.

Published
2021
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12. Association of obesity with 3-month mortality in kidney failure patients with COVID-19

Author

Tantisattamo, Ekamol, Imhof, Celine, Jager, Kitty J., Hilbrands, Luuk B., Guidotti, Rebecca, Islam, Mahmud, Katicic, Dajana, Konings, Constantijn, Molenaar, Femke M., Nistor, Ionut, Noordzij, Marlies, Rodríguez Ferrero, Mariá Luisa, Verhoeven, Martine A. M., de Vries, Aiko P. J., Kalantar-Zadeh, Kamyar, Gansevoort, Ron T., Vart, Priya, 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, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, Joaõ, Alferes, Daniela G., Zakharova, Elena V., Ambuehl, Patrice Max, Walker, Andrea, Lepeytre, Fanny, Rabate, Clementine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, 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., 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, Covic, Adrian, 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, Manzanos, Sagrario Balda, Haridian Sosa Barrios, R., Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Safak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, 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 H., Kumar, Mohan N., di Luca, Marina, Tuǧlular, Serhan Z., Ziekenhuis, Martini, Kramer, Andrea B., Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y., 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, Els van de Logt, Anne, Maas, Rutger, Duivenvoorden, Raphaël, 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, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Sahin, Idris, 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., Meijer, Esther, 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., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, 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., Rimsevicius, Laurynas, Righetti, Marco, Heitink-ter Braak, Nicole, Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, Nephrology, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, Clinical sciences, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, ACS - Diabetes & metabolism, Internal Medicine, Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), 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, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G, Zakharova, Elena V, Ambuehl, Patrice Max, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, 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, 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, Covic, Adrian, 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, Manzanos, Sagrario Balda, Haridian Sosa Barrios, R., Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A M J, Büttner, Stefan, 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, Kumar N, Mohan, Di Luca, Marina, Tuğlular, Serhan Z, Ziekenhuis, Martini, Kramer, Andrea B, Beerenhout, Charles, Luik, Peter T, Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y, 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, Els van de Logt, Anne, Maas, Rutger, Duivenvoorden, Raphaël, 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, Schouten, Marcel, 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, Meijer, Esther, 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, van Zuilen, Arjan D, Meijvis, Sabine C A, Dolmans, Helma, 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, and Heitink-Ter Braak, Nicole

Subjects
Transplantation, COVID-19, infectious diseases, mortality, DIALYSIS PATIENTS, kidney failure, BODY-MASS INDEX, obesity paradox, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], TRANSPLANT, SDG 3 - Good Health and Well-being, Nephrology, ERACODA, reverse epidemiology, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

Background In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19. Methods Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m2), divided into: Results In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (Pinteraction = 0.99), but differed by sex (Pinteraction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively. Conclusion In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.

Published
2022

13. 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

14. 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

15. 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

16. The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis

Author

Bouwmans, Pim, Brandts, Lloyd, Hilbrands, Luuk B, Duivenvoorden, Raphaël, Vart, Priya, Franssen, Casper F M, Covic, Adrian, Islam, Mahmud, Rabaté, Clémentine, Jager, Kitty J, Noordzij, Marlies, Gansevoort, Ron T, Hemmelder, Marc H, ERACODA collaborators, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Graduate School, Medical Informatics, APH - Quality of Care, APH - Aging & Later Life, ACS - Pulmonary hypertension & thrombosis, APH - Global Health, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, Nephrology, AII - Infectious diseases, UCL - (MGD) Service de néphrologie, Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, MUMC+: KIO Kemta (9), RS: GROW - R1 - Prevention, MUMC+: MA Nefrologie (9), Clinical sciences, Internal Medicine, Groningen Kidney Center (GKC), and Cardiovascular Centre (CVC)

Subjects
Chronic/complications, COVID-19/diagnosis, intensive care units, MULTICENTER, Fatigue Syndrome, Chronic/complications, frailty, infectious diseases, COVID-19 Testing, Renal Dialysis, Humans, KIDNEY-TRANSPLANT, Mortality, Aged, Transplantation, Fatigue Syndrome, Chronic, Frailty, COVID-19, CARE, Fatigue Syndrome, mortality, Intensive Care Units, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Frailty/diagnosis, Nephrology, dialysis, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], Triage, triage, Dialysis
Abstract

BackgroundSeveral guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (COVID-19) patients. This study evaluates the impact of CFS on intensive care unit (ICU) admission rate and hospital and ICU mortality rates in hospitalized dialysis patients with COVID-19.MethodsWe analysed data of dialysis patients diagnosed with COVID-19 from the European Renal Association COVID-19 Database. The primary outcome was ICU admission rate and secondary outcomes were hospital and ICU mortality until 3 months after COVID-19 diagnosis. Cox regression analyses were performed to assess associations between CFS and outcomes.ResultsA total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7–9 and highest (27%) in patients 65–75 years of age with a CFS of 5. A CFS of 7–9 was associated with a lower ICU admission rate than a CFS of 1–3 [relative risk 0.49 (95% confidence interval 0.27–0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7–9 (69%). Only 9% of patients with a CFS ≥6 survived after ICU admission. After adjustment for age and sex, each CFS category ≥4 was associated with higher hospital and ICU mortality compared with a CFS of 1–3.ConclusionsFrail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

Published
2022

17. Vaccination contre le SARS-CoV-2 chez le patient greffé rénal

Author

Georgery, Hélène, Devresse, Arnaud, Yombi, Jean Cyr, Goffin, Eric, Kanaan, Nada, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, and UCL - (SLuc) Département de médecine interne et services associés

Subjects
vaccine, COVID-19, Kidney Transplant
Abstract

Les patients greffés rénaux sont plus à risque que la population générale de développer une forme sévère - fatale - de la COVID-19 contre laquelle l’arsenal thérapeutique actuel reste limité. Malheureusement, comme chez la plupart des immunodéprimés, la réponse à un schéma standard de vaccination contre le SARS-CoV-2 chez ces patients est nettement sub-optimale. En effet, la littérature récente montre une réponse humorale de l’ordre de 50%, 1 mois après 2 doses d’un vaccin ARN messager (ARNm). En outre, les taux d’anticorps atteints sont souvent faibles à modérés. Notre expérience aux Cliniques universitaires Saint-Luc est similaire. Face à ces résultats décevants, d’autres stratégies sont nécessaires pour les patients greffés rénaux et immunodéprimés, incluant l’utilisation d’une troisième dose de vaccin et éventuellement l’utilisation d’anticorps monoclonaux. Le but de ce travail est de réaliser une revue de la littérature sur ces questions, et derapporter notre expérience locale.

Published
2021

18. Renin-Angiotensin System Blockers and the Risk of COVID-19-Related Mortality in Patients with Kidney Failure

Author

Soler, Maria Jose, Noordzij, Marlies, Abramowicz, Daniel, de Arriba, Gabriel, Basile, Carlo, van Buren, Marjolijn, Covic, Adrian, Crespo, Marta, Duivenvoorden, Raphaël, Massy, Ziad A, Ortiz, Alberto, Sanchez, J Emilio, Petridou, Emily, Stevens, Kate, White, Colin, Vart, Priya, Gansevoort, Ron T, ERACODA Collaborators, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, ERACODA Collaborators, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Hôpital Ambroise Paré [AP-HP], Nierstichting European Renal Association-European Dialysis and Transplant Association, ERA-EDTA, This work was supported by ERA-EDTA, Nierstichting (Dutch Kidney Foundation), Baxter, and Sandoz unrestricted research grants., UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Clinical sciences, Nephrology, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Medical Informatics, and Graduate School

Subjects
Male, Epidemiology, BLOCKADE, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Angiotensin-Converting Enzyme Inhibitors, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, law, 80 and over, Renal Insufficiency, Kidney transplantation, Aged, 80 and over, Kidney, education.field_of_study, COVID-19/mortality, renin angiotensin system, Hazard ratio, LOCALIZATION, Angiotensin Receptor Antagonists/adverse effects, Middle Aged, Intensive care unit, 3. Good health, Hospitalization, medicine.anatomical_structure, Angiotensin-Converting Enzyme Inhibitors/adverse effects, Nephrology, ERACODA, Renin angiotensin system, Female, Angiotensin-Converting Enzyme 2, medicine.medical_specialty, Population, Kidney failure, kidney transplantation, CONVERTING ENZYME-2, Article, 03 medical and health sciences, Angiotensin Receptor Antagonists, All institutes and research themes of the Radboud University Medical Center, Internal medicine, Renin–angiotensin system, medicine, Humans, Angiotensin-Converting Enzyme 2/physiology, Renal Insufficiency/complications, cardiovascular diseases, education, Dialysis, Aged, Proportional Hazards Models, Transplantation, business.industry, SARS-CoV-2, COVID-19, medicine.disease, Kidney Transplantation, Discontinuation, DIALYSIS PATIENTS, kidney failure, dialysis, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], TRANSPLANT, REGISTRY, Human medicine, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business
Abstract

Background and objectives: There is concern about potential deleterious effects of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). Patients with kidney failure, who often use ACEis/ARBs, are at higher risk of more severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population.Design, setting, participants, & measurements: From the European Renal Association COVID-19 database (ERACODA), we retrieved data on kidney transplant recipients and patients on dialysis who were affected by COVID-19, between February 1 and October 1, 2020, and had information on 28-day mortality. We used Cox proportional-hazards regression to calculate hazard ratios for the association between ACEi/ ARB use and 28-day mortality risk. Additionally, we studied the association of discontinuation of these agents with 28-day mortality.Results: We evaluated 1511 patients: 459 kidney transplant recipients and 1052 patients on dialysis. At diagnosis of COVID-19, 189 (41%) of the transplant recipients and 288 (27%) of the patients on dialysis were on ACEis/ ARBs. A total of 88 (19%) transplant recipients and 244 (23%) patients on dialysis died within 28 days of initial presentation. In both groups of patients, there was no association between ACEi/ ARB use and 28-day mortality in both crude and adjusted models (in transplant recipients, adjusted hazard ratio, 1.12; 95% confidence interval [95% CI], 0.69 to 1.83; in patients on dialysis, adjusted hazard ratio, 1.04; 95% CI, 0.73 to 1.47). Among transplant recipients, ACEi/ARB discontinuation was associated with a higher mortality risk after adjustment for demographics and comorbidities, but the association was no longer statistically significant after adjustment for severity of COVID-19 (adjusted hazard ratio, 1.36; 95% CI, 0.40 to 4.58). Among patients on dialysis, ACEi/ARB discontinuation was not associated with mortality in any model. We obtained similar results across subgroups when ACEis and ARBs were studied separately, and when other outcomes for severity of COVID-19 were studied, e.g., hospital admission, admission to the intensive care unit, or need for ventilator support.Conclusions: Among kidney transplant recipients and patients on dialysis with COVID-19, there was no significant association of ACEi/ ARB use or discontinuation with mortality.

Published
2021

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