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      Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey

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      Nephrology Dialysis Transplantation
      Oxford University Press
      COVID-19, haemodialysis, kidney disease, mortality, renal transplantation

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          Abstract

          Background

          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.

          Methods

          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.

          Results

          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].

          Conclusions

          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.

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          Most cited references33

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

            There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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              A new equation to estimate glomerular filtration rate.

              Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.
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                Author and article information

                Journal
                Nephrol Dial Transplant
                Nephrol Dial Transplant
                ndt
                Nephrology Dialysis Transplantation
                Oxford University Press
                0931-0509
                1460-2385
                December 2020
                04 December 2020
                04 December 2020
                : 35
                : 12
                : 2083-2095
                Affiliations
                [g1 ] Department of Nephrology, University of Health Sciences, Haseki Training and Research Hospital , Istanbul, Turkey
                [g2 ] Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Mersin University Training and Research Hospital , Mersin, Turkey
                [g3 ] Department of Nephrology, Faculty of Medicine, Hacettepe University , Ankara, Turkey
                [g4 ] Department of Nephrology, University of Health Sciences, Sultan 2.Abdulhamid Han Training and Research Hospital , Istanbul, Turkey
                [g5 ] Department of Internal Medicine, Division of Nephrology, Istanbul University – Cerrahpasa Cerrahpasa Faculty of Medicine , Istanbul, Turkey
                [g6 ] Department of Nephrology, Darica Farabi Training and Research Hospital , Kocaeli, Turkey
                [g7 ] Department of Nephrology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences , Istanbul, Turkey
                [g8 ] Department of Internal Medicine, Division of Nephrology, Izmir Katip Celebi University, Atatürk Training and Research Hospital , Izmir, Turkey
                [g9 ] Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University , Eskisehir, Turkey
                [g10 ] Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital , Istanbul, Turkey
                [g11 ] Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Recep Tayyip Erdogan University , Rize, Turkey
                [g12 ] Department of Internal Medicine, Division of Nephrology, Sakarya University Training and Research Hospital , Sakarya, Turkey
                [g13 ] Department of Nephrology, Faculty of Medicine, Kocaeli University , Kocaeli, Turkey
                [g14 ] Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Akdeniz University , Antalya, Turkey
                [g15 ] Department of Nephrology, Zonguldak Ataturk State Hospital , Zonguldak, Turkey
                [g16 ] Department of Nephrology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital , Istanbul, Turkey
                [g17 ] Department of Nephrology, University of Health Sciences, Kocaeli Derince Training and Research Hospital , Kocaeli, Turkey
                [g18 ] Department of Nephrology, Bursa City Hospital , Bursa, Turkey
                [g19 ] Department of Nephrology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital , Trabzon, Turkey
                [g20 ] Department of Internal Medicine, Division of Nephrology, Canakkale Onsekiz Mart University , Canakkale, Turkey
                [g21 ] Department of Internal Medicine, Division of Nephrology, Istanbul University Faculty of Medicine , Istanbul, Turkey
                [g22 ] Department of Nephrology, Kahramanmaras Sutcu Imam University Faculty of Medicine , Kahramanmaras, Turkey
                [g23 ] Department of Internal Medicine, Division of Nephrology, Inonu University Faculty of Medicine, Turgut Ozal Medical Center , Malatya, Turkey
                [g24 ] Department of Internal Medicine, Division of Nephrology, Marmara University Faculty of Medicine, Marmara University Pendik Training and Research Hospital , Istanbul, Turkey
                [g25 ] Department of Internal Medicine, Division of Nephrology, Yeni Yuzyil University Faculty of Medicine , Istanbul, Turkey
                [g26 ] Department of Nephrology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital , Ankara, Turkey
                [g27 ] Department of Internal Medicine, Division of Nephrology, Mugla Sitki Kocman University Faculty of Medicine, Training and Research Hospital , Mugla, Turkey
                [g28 ] Department of Internal Medicine, Division of Nephrology, Memorial Hizmet Hospital , Istanbul, Turkey
                [g29 ] Department of Nephrology, University of Health Sciences, Bursa Higher Specialization Training and Research Hospital , Bursa, Turkey
                [g30 ] Department of Nephrology, University of Health Sciences, Ankara Training and Research Hospital , Ankara, Turkey
                [g31 ] Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Bagcilar Training and Research Hospital , Istanbul, Turkey
                [g32 ] Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Training and Research Hospital , Izmir, Turkey
                [g33 ] Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Usak University , Usak, Turkey
                [g34 ] Department of Nephrology, Malatya Training and Research Hospital , Malatya, Turkey
                [g35 ] Department of Nephrology, Manisa Merkezefendi State Hospital , Manisa, Turkey
                [g36 ] Department of Nephrology, Balıkesir Ataturk City Hospital , Balikesir, Turkey
                [g37 ] Department of Nephrology, Kocaeli State Hospital , Kocaeli, Turkey
                [g38 ] Department of Nephrology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital , Izmir, Turkey
                [g39 ] Department of Internal Medicine, Division of Nephrology, Bezmialem Vakif University Faculty of Medicine , Istanbul, Turkey
                [g40 ] Department of Nephrology, Bursa Uludag University Faculty of Medicine , Bursa, Turkey
                [g41 ] Department of Nephrology, University of Health Sciences, Diyarbakır Gazi Yasargil Training and Research Hospital , Diyarbakir, Turkey
                [g42 ] Department of Nephrology, Adana City Training and Research Hospital , Adana, Turkey
                [g43 ] Department of Nephrology, Necmettin Erbakan University Meram Faculty of Medicine , Konya, Turkey
                [g44 ] Department of Nephrology, Hakkari State Hospital , Hakkari, Turkey
                [g45 ] Department of Internal Medicine, Division of Nephrology, Firat University Faculty of Medicine , Elazig, Turkey
                [g46 ] Department of Transplantation, Koc University Hospital , Istanbul, Turkey
                [g47 ] Department of Nephrology, University of Health Sciences, Mehmet Akif Inan Training and Research Hospital , Sanliurfa, Turkey
                [g48 ] Department of Internal Medicine, Division of Nephrology, Sakarya University Faculty of Medicine, Training and Research Hospital , Sakarya, Turkey
                [g49 ] Department of Internal Medicine, Division of Nephrology, University of Health Sciences, Tepecik Training and Research Hospital , Izmir, Turkey
                [g50 ] Department of Nephrology, Erciyes University Faculty of Medicine , Kayseri, Turkey
                [g51 ] Department of Internal Medicine, Division of Nephrology, Atilim University Faculty of Medicine , Istanbul, Turkey
                [g52 ] Department of Internal Medicine, Division of Nephrology, Ankara University Faculty of Medicine Ankara , Turkey
                Author notes
                Correspondence to: Mustafa Arici; E-mail: marici@ 123456hacettepe.edu.tr ; marici18@ 123456yahoo.com
                Author information
                http://orcid.org/0000-0002-4055-7896
                http://orcid.org/0000-0003-1284-916X
                http://orcid.org/0000-0002-2229-5140
                http://orcid.org/0000-0003-2015-4421
                http://orcid.org/0000-0003-2804-4884
                http://orcid.org/0000-0003-2491-4926
                Article
                gfaa271
                10.1093/ndt/gfaa271
                7716804
                33275763
                8ef72591-ecb6-4f72-a6de-6eac422d5446
                © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 30 June 2020
                : 01 October 2020
                Page count
                Pages: 13
                Funding
                Funded by: Turkish Society of Nephrology, DOI 10.13039/501100004413;
                Categories
                ORIGINAL ARTICLES
                Clinical Research
                AcademicSubjects/MED00340

                Nephrology
                covid-19,haemodialysis,kidney disease,mortality,renal transplantation
                Nephrology
                covid-19, haemodialysis, kidney disease, mortality, renal transplantation

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