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Sex differences in COVID-19 mortality risk in patients on kidney function replacement therapy

Lookup NU author(s): Dr Ian Logan

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Abstract

© 2022, The Author(s). 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 < 0.001) in females (pinteraction = 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.

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Author(s): Vart P, Duivenvoorden R, Adema A, Covic A, Finne P, Braak NH-T, Laine K, Noordzij M, Schouten M, Jager KJ, Gansevoort RT, van der Net JB, Essig M, du Buf-Vereijken PWG, van Ginneken B, Maas N, van Jaarsveld BC, Bemelman FJ, Klingenberg-Salahova F, Heenan-Vos F, Vervloet MG, Nurmohamed A, Vogt L, Abramowicz D, Verhofstede S, Maoujoud O, Malfait T, Fialova J, Melilli E, Fava A, Cruzado JM, Perez NM, Lips J, Krepel H, Adilovic H, Radulescu D, Hengst M, Konings C, Rydzewski A, Braconnier P, Weis D, Gellert R, Oliveira J, Alferes DG, Zakharova EV, Ambuhl PM, Guidotti R, Walker A, Lepeytre F, Rabate C, Rostoker G, Marques S, Azasevac T, Majstorovic GS, Katicic D, ten Dam M, Kruger T, Brzosko S, Liakopoulos V, Zanen AL, Logtenberg SJJ, Fricke L, Kuryata O, Slebe JJP, ElHafeez SA, Kemlin D, van de Wetering J, Reinders MEJ, Hesselink DA, Kal-van Gestel J, Eiselt J, Kielberger L, El-Wakil HS, Verhoeven M, Logan I, Canal C, Facundo C, Ramos AM, Debska-Slizien A, Veldhuizen NMH, Tigka E, Konsta MAP, Panagoutsos S, Mallamaci F, Postorino A, Cambareri F, Matceac I, Nistor I, Groeneveld JHM, Jousma J, van Buren M, Diekmann F, Oppenheimer F, Blasco M, Pereira TA, Santos ACS, Arias-Cabrales C, Crespo M, Llinas-Mallol L, Buxeda A, Tarrega CB, Redondo-Pachon D, Jimenez MDA, Mendoza-Valderrey A, Martins AC, Mateus C, Alvila G, Laranjinha I, Hofstra JM, Siezenga MA, Franco A, Arroyo D, Castellano S, Rodriguez-Ferrero ML, Manzanos SB, Barrios RHS, Lemahieu W, Bartelet K, Dirim AB, Demir E, Sever MS, Turkmen A, Safak S, Hollander DAMJ, Buttner S, de Vries APJ, Meziyerh S, van der Helm D, Mallat M, Bouwsma H, Sridharan S, Petruliene K, Maloney S-R, Verberk I, van der Sande FM, Christiaans MHL, Hemmelder MH, MohanKumar N, Di Luca M, Tuglular SZ, Kramer AB, Beerenhout C, Luik PT, Kerschbaum J, Tiefenthaler M, Watschinger B, Stepanov VA, Zulkarnaev AB, Turkmen K, Gandolfini I, Maggiore U, Fliedner A, Asberg A, Mjoen G, Miyasato H, de Fijter CWH, Mongera N, Pini S, de Biase C, Kerckhoffs A, van de Logt AE, Maas R, Hilbrands LB, Lebedeva O, Lopez V, Reichert LJM, Verhave J, Titov D, Parshina EV, Zanoli L, Marcantoni C, van Kempen G, van Gils-Verrij LEA, Harty JC, Meurs M, Myslak M, Battaglia Y, Lentini P, den Deurwaarder E, Stendahl M, Rahimzadeh H, Rychlik I, Cabezas-Reina CJ, Roca AM, Nauta F, Sahin I, Goffin E, Kanaan N, Labriola L, Devresse A, Diaz-Mareque A, Coca A, de Arriba G, Meijers BKI, Naesens M, Kuypers D, Desschans B, Tonnerlier A, Wissing KM, Dedinska I, Pessolano G, Malik S, Dounousi E, Papachristou E, Berger SP, Sanders JSF, Franssen CFM, Ozyilmaz A, Ponikvar JB, Pernat AM, Kovac D, Arnol M, Ekart R, Abrahams AC, Molenaar FM, van Zuilen AD, Meijvis SCA, Dolmans H, Tantisattamo E, Esposito P, Krzesinski J-M, Barahira JD, Gallieni M, Martin-Moreno PL, Guglielmetti G, Guzzo G, Toapanta N, Soler MJ, Luik AJ, van Kuijk WHM, Stikkelbroeck LWH, Hermans MMH, Rimsevicius L, Righetti M, Islam M

Publication type: Article

Publication status: Published

Journal: Scientific Reports

Year: 2022

Volume: 12

Issue: 1

Online publication date: 26/10/2022

Acceptance date: 18/10/2022

Date deposited: 07/11/2022

ISSN (electronic): 2045-2322

Publisher: Nature Publishing Group

URL: https://doi.org/10.1038/s41598-022-22657-4

DOI: 10.1038/s41598-022-22657-4

PubMed id: 36289317

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