Savas Ozturk g1 , Kenan Turgutalp g2 , Mustafa Arici g3 , Ali Riza Odabas g4 , Mehmet Riza Altiparmak g5 , Zeki Aydin g6 , Egemen Cebeci g1 , Taner Basturk g7 , Zeki Soypacaci g8 , Garip Sahin g9 , Tuba Elif Ozler g10 , Ekrem Kara g11 , Hamad Dheir g12 , Necmi Eren g13 , Gultekin Suleymanlar g14 , Mahmud Islam g15 , Melike Betul Ogutmen g16 , Erkan Sengul g17 , Yavuz Ayar g18 , Murside Esra Dolarslan g19 , Serkan Bakirdogen g20 , Seda Safak g21 , Ozkan Gungor g22 , Idris Sahin g23 , Ilay Berke Mentese g24 , Ozgur Merhametsiz g25 , Ebru Gok Oguz g26 , Dilek Gibyeli Genek g27 , Nadir Alpay g28 , Nimet Aktas g29 , Murat Duranay g30 , Selma Alagoz g31 , Hulya Colak g32 , Zelal Adibelli g33 , Irem Pembegul g34 , Ender Hur g35 , Alper Azak g36 , Dilek Guven Taymez g37 , Erhan Tatar g38 , Rumeyza Kazancioglu g39 , Aysegul Oruc g40 , Enver Yuksel g41 , Engin Onan g42 , Kultigin Turkmen g43 , Nuri Baris Hasbal g44 , Ali Gurel g45 , Berna Yelken g46 , Tuncay Sahutoglu g47 , Mahmut Gok g4 , Nurhan Seyahi g5 , Mustafa Sevinc g7 , Sultan Ozkurt g9 , Savas Sipahi g48 , Sibel Gokcay Bek g13 , Feyza Bora g14 , Bulent Demirelli g16 , Ozgur Akin Oto g21 , Orcun Altunoren g22 , Serhan Zubeyde Tuglular g24 , Mehmet Emin Demir g25 , Mehmet Deniz Ayli g26 , Bulent Huddam g27 , Mehmet Tanrisev g49 , Ilter Bozaci g38 , Meltem Gursu g39 , Betul Bakar g30 , Bulent Tokgoz g50 , Halil Zeki Tonbul g42 , Alaattin Yildiz g21 , Siren Sezer g51 , Kenan Ates g52
04 December 2020
Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3–5), HD and RT patients with a control group of patients is still lacking.
We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3–5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared.
A total of 1210 patients were included [median age, 61 (quartile 1–quartile 3 48–71) years, female 551 (45.5%)] composed of four groups: control ( n = 450), HD ( n = 390), RT ( n = 81) and CKD ( n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9–45.2; and 82/289 (28.4%); 95% CI 23.9–34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3–29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2–30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7–19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8–10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5–6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52–5.44); P = 0.001; 2.44 (1.35–4.40); P = 0.003; HD: 2.32 (1.21–4.46); P = 0.011; 2.25 (1.23–4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76–4.72); P = 0.169; 1.87 (0.81–4.28); P = 0.138, respectively].
Hospitalized COVID-19 patients with CKDs, including Stages 3–5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3–5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.