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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 references 34

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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 Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19

              Abstract Background No therapeutics have yet been proven effective for the treatment of severe illness caused by SARS-CoV-2. Methods We conducted a randomized, controlled, open-label trial involving hospitalized adult patients with confirmed SARS-CoV-2 infection, which causes the respiratory illness Covid-19, and an oxygen saturation (Sao 2) of 94% or less while they were breathing ambient air or a ratio of the partial pressure of oxygen (Pao 2) to the fraction of inspired oxygen (Fio 2) of less than 300 mm Hg. Patients were randomly assigned in a 1:1 ratio to receive either lopinavir–ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days, in addition to standard care, or standard care alone. The primary end point was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a seven-category ordinal scale or discharge from the hospital, whichever came first. Results A total of 199 patients with laboratory-confirmed SARS-CoV-2 infection underwent randomization; 99 were assigned to the lopinavir–ritonavir group, and 100 to the standard-care group. Treatment with lopinavir–ritonavir was not associated with a difference from standard care in the time to clinical improvement (hazard ratio for clinical improvement, 1.24; 95% confidence interval [CI], 0.90 to 1.72). Mortality at 28 days was similar in the lopinavir–ritonavir group and the standard-care group (19.2% vs. 25.0%; difference, −5.8 percentage points; 95% CI, −17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. In a modified intention-to-treat analysis, lopinavir–ritonavir led to a median time to clinical improvement that was shorter by 1 day than that observed with standard care (hazard ratio, 1.39; 95% CI, 1.00 to 1.91). Gastrointestinal adverse events were more common in the lopinavir–ritonavir group, but serious adverse events were more common in the standard-care group. Lopinavir–ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events. Conclusions In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit. (Funded by Major Projects of National Science and Technology on New Drug Creation and Development and others; Chinese Clinical Trial Register number, ChiCTR2000029308.)
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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
                Article
                gfaa271
                10.1093/ndt/gfaa271
                7716804
                33275763
                © 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

                Page count
                Pages: 13
                Product
                Funding
                Funded by: Turkish Society of Nephrology, DOI 10.13039/501100004413;
                Categories
                ORIGINAL ARTICLES
                Clinical Research
                AcademicSubjects/MED00340

                Nephrology

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

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