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0 0.5 1 1.5 2+ Mortality 43% Improvement Relative Risk HCQ for COVID-19  Alberici et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 94 patients in Italy Lower mortality with HCQ (not stat. sig., p=0.12) Alberici et al., Kidney Int., 20-26, J.., May 2020 Favors HCQ Favors control

A report from the Brescia Renal COVID Task Force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection

Alberici et al., Kidney Int., 98:1, 20-26, July 1, 2020, doi:10.1016/j.kint.2020.04.030 (date from preprint)
May 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 421 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
Analysis of 94 hemodialysis COVID-19 positive patients, showing lower mortality with HCQ treatment, not reaching statistical significance.
risk of death, 42.9% lower, RR 0.57, p = 0.12, treatment 17 of 72 (23.6%), control 9 of 22 (40.9%), NNT 5.8, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Alberici et al., 10 May 2020, retrospective, Italy, peer-reviewed, 31 authors, average treatment delay 4.0 days.
This PaperHCQAll
A report from the Brescia Renal COVID Task Force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection
Federico Alberici, Elisa Delbarba, Chiara Manenti, Laura Econimo, Francesca Valerio, Alessandra Pola, Camilla Maffei, Stefano Possenti, Bernardo Lucca, Roberta Cortinovis, Vincenzo Terlizzi, Mattia Zappa, Chiara Saccà, Elena Pezzini, Eleonora Calcaterra, Paola Piarulli, Alice Guerini, Francesca Boni, Agnese Gallico, Alberto Mucchetti, Stefania Affatato, Sergio Bove, Martina Bracchi, Ester Maria Costantino, Roberto Zubani, Corrado Camerini, Paola Gaggia, Ezio Movilli, Nicola Bossini, Mario Gaggiotti, Francesco Scolari
Kidney International, doi:10.1016/j.kint.2020.04.030
The SARS-CoV-2 epidemic is pressuring healthcare systems worldwide. Disease outcomes in certain subgroups of patients are still scarce, and data are needed. Therefore, we describe here the experience of four dialysis centers of the Brescia Renal COVID Task Force. During March 2020, within an overall population of 643 hemodialysis patients, SARS-CoV-2 RNA positivity was detected in 94 (15%). At disease diagnosis, 37 of the 94 (39%) patients (group 1) were managed on an outpatient basis, whereas the remaining 57 (61%) (group 2) required hospitalization. Choices regarding management strategy were made based on disease severity. In group 1, 41% received antivirals and 76% hydroxychloroquine. Eight percent died and 5% developed acute respiratory distress syndrome (ARDS). In group 2, 79% received antivirals and 77% hydroxychloroquine. Forty two percent died and 79% developed ARDS. Overall mortality rate for the entire cohort was 29%. History of ischemic cardiac disease, fever, older age (over age 70), and dyspnea at presentation were associated with the risk of developing ARDS, whereas fever, cough and a C-reactive protein higher than 50 mg/l at disease presentation were associated with the risk of death. Thus, in our population of hemodialysis patients with SARS-CoV-2 infection, we documented a wide range of disease severity. The risk of ARDS and death is significant for patients requiring hospital admission at disease diagnosis.
Alberici, Delbarba, Manenti, A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia, Kidney Int
Alberici, Delbarba, Manenti, Management of patients on dialysis and with kidney transplantation during the SARS-CoV-2 (COVID-19) pandemic in Brescia, Italy, Kidney Int Rep
Banerjee, Popoola, Shah, COVID-19 infection in kidney transplant recipients, Kidney Int
Burgner, Ikizler, Dwyer, COVID-19 and the inpatient dialysis unit: managing resources during contingency planning pre-crisis, Clin J Am Soc Nephrol
Force, Ranieri, Rubenfeld, Acute respiratory distress syndrome: the Berlin Definition, JAMA
Henry, Lippi, Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Mcmichael, Currie, Clark, Epidemiology of Covid-19 in a long-term care facility in King County, Washington, N Engl J Med
Onder, Rezza, Brusaferro, Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy
Wang, Liao, He, COVID-19 in hemodialysis patients: a report of 5 cases
Wu, Chen, Cai, Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus disease 2019 pneumonia in Wuhan, China
Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention, JAMA
Yancy, Jessup, Bozkurt, ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines, J Am Coll Cardiol
Yang, Yu, Xu, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, Lancet Respir Med
Late treatment
is less effective
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