COVID-19 in patients undergoing chronic kidney replacement therapy and kidney transplant recipients in Scotland: findings and experience from the Scottish renal registry
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Background
Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland.
Methods
Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed.
Results
During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients.
Conclusion
The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.
Article activity feed
-
SciScore for 10.1101/2020.07.12.20148197: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data held by the registry include patient demographics including historical postcodes (for calculating Scottish Index of Multiple Deprivation), full RRT history (for ESRD), date and cause of death (using ERA-EDTA codes), primary renal diagnosis (using ERA-EDTA codes) and monthly linkage with National Health Service Blood and Transplant (NHS BT) for transplant status. ERA-EDTAsuggested: (ERA-EDTA, RRID:SCR_003982)Results from OddPub: We did not detect open data. We also did not …
SciScore for 10.1101/2020.07.12.20148197: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data held by the registry include patient demographics including historical postcodes (for calculating Scottish Index of Multiple Deprivation), full RRT history (for ESRD), date and cause of death (using ERA-EDTA codes), primary renal diagnosis (using ERA-EDTA codes) and monthly linkage with National Health Service Blood and Transplant (NHS BT) for transplant status. ERA-EDTAsuggested: (ERA-EDTA, RRID:SCR_003982)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:However, limitations of our study are that we did not have data on hospitalisations, co-morbidities or smoking status. Fortunately, our numbers were small. However, this limits our ability to draw conclusions from our analyses. Furthermore we do not hold data on medication use so cannot infer whether any medications, such as renin angiotensin system inhibition, was associated with different risks of infection or adverse outcome as has been investigated elsewhere 26,27. Only symptomatic patients were tested, so we cannot comment on the asymptomatic rate of SARS-CoV-2 infection, this may have led to lower case ascertainment in the population of patients with kidney transplants. However, unlike in the wider UK population, testing was performed liberally, and to the best of our knowledge in all symptomatic patients requiring dialysis and in those without symptoms but who presented with fever. In summary, we demonstrate that 2% of the RRT population had a positive test for SARS-CoV-2 during the period of study. The incidence of positive tests fell following instigation of infection control measures. Mortality is high and it is unclear if any of the therapies demonstrated to improve outcomes in patients with COVID-19 such as dexamethasone or remdesivir will have efficacy in patients requiring RRT. Patients requiring dialysis were excluded from recent remdesivir trials 28. It is likely that in the absence of specific therapy, and high mortality, heightened vigilance of the risk of S...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
-
-
