ASN Kidney Week: Research uncovers why dialysis and transplant patients are more likely to die from COVID-19

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People with kidney failure who are on dialysis or who have received a kidney transplant face a higher risk of dying from COVID-19—and new research has revealed that these individuals have profound immune system-related differences compared with people with normal kidney function, with these differences being further amplified by SARS-CoV-2 infection.

This is according to the findings of a study presented at American Society of Nephrology (ASN) Kidney Week (2–7 November 2021, virtual). The study included 32 patients who were on haemodialysis, or who received a kidney transplant, and were hospitalised for COVID-19, as well as 12 dialysis or transplant patients without COVID-19 and 10 healthy controls.

Patients with a severe COVID-19 course were older and showed lower counts of immune cells called lymphocytes and monocytes compared to patients with a benign disease course. Patients without COVID-19 had lower numbers of all major immune cell subsets compared with healthy patients, and these numbers were further reduced in patients with COVID-19—especially in patients with a severe disease course.

Investigators noted several other immune system-related differences between these patients and the healthy controls.

“Although dialysis and kidney transplant patients are inherently heterogeneous groups, the immunological abnormalities during COVID-19 are similar across the two cohorts, with the exception of more pronounced defects in innate immunity and a dampened antibody response in kidney transplant patients,” said lead author Stefania Affatato (Università di Brescia, ASST Spedali Civili di Brescia, Brescia, Italy).

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