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Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort

Lano et al., Clinical Kidney Journal, 13:5, October 2020, 878–888, doi:10.1093/ckj/sfaa199
Oct 2020  
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Mortality 33% Improvement Relative Risk Death/ICU 39% Death/ICU (b) 69% HCQ for COVID-19  Lano et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 122 patients in France Lower mortality (p=0.28) and death/ICU (p=0.23), not sig. c19hcq.org Lano et al., Clinical Kidney J., Octob.., Oct 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
33% lower mortality with HCQ+AZ, p=0.28. Retrospective 122 French dialysis patients.
69% lower combined mortality/ICU, p=0.11, for the subgroup not requiring O2 on diagnosis (slightly earlier treatment).
Although the 33% lower mortality is not statistically significant, it is consistent with the significant 26% lower mortality [22‑30%] from meta analysis of the 249 mortality results to date.
risk of death, 33.1% lower, RR 0.67, p = 0.28, treatment 56, control 66, adjusted per study, odds ratio converted to relative risk.
risk of death/ICU, 38.9% lower, RR 0.61, p = 0.23, treatment 17 of 56 (30.4%), control 28 of 66 (42.4%), NNT 8.3, adjusted per study, odds ratio converted to relative risk.
risk of death/ICU, 68.7% lower, RR 0.31, p = 0.11, treatment 4 of 36 (11.1%), control 11 of 31 (35.5%), NNT 4.1, not requiring O2 on diagnosis (relatively early treatment).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lano et al., 21 Oct 2020, retrospective, France, peer-reviewed, median age 73.5, 30 authors.
This PaperHCQAll
Risk factors for severity of COVID-19 in chronic dialysis patients from a multicentre French cohort
Guillaume Lano, Antoine Braconnier, Stanislas Bataille, Guilhem Cavaille, Julie Moussi-Frances, Bertrand Gondouin, Pascal Bindi, Magued Nakhla, Janette Mansour, Pascale Halin, Bénédicte Levy, Eric Canivet, Khaled Gaha, Isabelle Kazes, Natacha Noel, Alain Wynckel, Alexandre Debrumetz, Noemie Jourde-Chiche, Valerie Moal, Romain Vial, Violaine Scarfoglière, Mickael Bobot, Marion Gully, Tristan Legris, Marion Pelletier, Marion Sallee, Stephane Burtey, Philippe Brunet, Thomas Robert, Philippe Rieu
Clinical Kidney Journal, doi:10.1093/ckj/sfaa199
Background. Coronavirus disease 2019 (COVID-19) is an emerging infectious disease, related to severe acute respiratory syndrome coronavirus 2 infection. Few data are available in patients with end-stage renal disease (ESRD). Methods. We conducted an observational cohort study of COVID-19 patients at 11 dialysis centres in two distinct districts of France to examine the epidemiological and clinical characteristics of COVID-19 in this population, and to determine risk factors of disease severity (defined as a composite outcome including intensive care unit admission or death) and mortality. Results. Among the 2336 patients enrolled, 5.5% had confirmed COVID-19 diagnosis. Of the 122 patients with a follow-up superior to 28 days, 37% reached the composite outcome and 28% died. Multivariate analysis showed that oxygen therapy on diagnosis and a decrease in lymphocyte count were independent risk factors associated with disease severity and with mortality. Chronic use of angiotensin II receptor blockers (ARBs) (18% of patients) was associated with a protective effect on mortality. Treatment with azithromycin and hydroxychloroquine (AZT/HCQ) (46% of patients) were not associated with the composite outcome and with death in univariate and multivariate analyses. Conclusions. COVID-19 is a severe disease with poor prognosis in patients with ESRD. Usual treatment with ARBs seems to be protective of critical evolution and mortality. There is no evidence of clinical benefit with the combination of AZT/HCQ.
SUPPLEMENTARY DATA Supplementary data are available at ckj online. AUTHORS' CONTRIBUTIONS G.L., A.B., T.R. and P.R. conceived and designed the study, and drafted the manuscript. S.Bataille, G.C., J.M.-F., B.G., P.Bindi, M.N., J.M., P.H., B.L., E.C., K.G., I.K., N.N., A.W., A.D., N.J.-C., V.M., R.V., V.S., M.B., M.G., T.L., M.P., M.S., S.Burtey and P.Brunet were involved in data collection analysis and provided guidance. All authors critically revised the manuscript for important intellectual content and approved the final version for publication. CONFLICT OF INTEREST STATEMENT All the authors declare that they have no conflict of interest.
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Few data are available in patients with ' 'end-stage renal disease ' '(ESRD).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted an ' 'observational cohort study of COVID-19 patients at 11 dialysis centres in two distinct ' 'districts of France to examine the epidemiological and clinical characteristics of COVID-19 ' 'in this population, and to determine risk factors of disease severity (defined as a composite ' 'outcome including intensive care unit admission or death) and ' 'mortality.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among the ' '2336 patients enrolled, 5.5% had confirmed COVID-19 diagnosis. Of the 122 patients with a ' 'follow-up superior to 28\u2009days, 37% reached the composite outcome and 28% died. ' 'Multivariate analysis showed that oxygen therapy on diagnosis and a decrease in lymphocyte ' 'count were independent risk factors associated with disease severity and with mortality. ' 'Chronic use of angiotensin II receptor blockers (ARBs) (18% of patients) was associated with ' 'a protective effect on mortality. Treatment with azithromycin and hydroxychloroquine ' '(AZT/HCQ) (46% of patients) were not associated with the composite outcome and with death in ' 'univariate and multivariate ' 'analyses.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>COVID-19 ' 'is a severe disease with poor prognosis in patients with ESRD. Usual treatment with ARBs ' 'seems to be protective of critical evolution and mortality. 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'first-page': '2264', 'DOI': '10.3390/jcm9072264', 'article-title': 'The spectrum of clinical and serological features of COVID-19 in urban ' 'hemodialysis patients', 'volume': '9', 'author': 'Stock da Cunha', 'year': '2020', 'journal-title': 'J Clin Med'}, { 'key': '2021013016561624000_sfaa199-B16', 'doi-asserted-by': 'crossref', 'first-page': '328', 'DOI': '10.1093/ckj/sfaa086', 'article-title': 'Clinical outcomes of hemodialysis patients infected with severe acute ' 'respiratory syndrome coronavirus 2 and impact of proactive chest ' 'computed tomography scans', 'volume': '13', 'author': 'Wang', 'year': '2020', 'journal-title': 'Clin Kidney J'}, { 'key': '2021013016561624000_sfaa199-B17', 'doi-asserted-by': 'crossref', 'DOI': '10.1053/j.ajkd.2020.07.001', 'article-title': 'COVID-19 outbreak in an urban hemodialysis unit', 'author': 'Yau', 'year': '2020', 'journal-title': 'Am J Kidney Dis'}, { 'key': '2021013016561624000_sfaa199-B18', 'doi-asserted-by': 'crossref', 'first-page': '275', 'DOI': '10.6002/ect.2020.0194', 'article-title': 'Incidence and immunologic analysis of coronavirus disease (COVID-19) in ' 'hemodialysis patients: a single-center experience', 'volume': '18', 'author': 'Arslan', 'year': '2020', 'journal-title': 'Exp Clin Transplant'}, { 'key': '2021013016561624000_sfaa199-B19', 'doi-asserted-by': 'crossref', 'first-page': '131', 'DOI': '10.1016/j.ijid.2020.04.086', 'article-title': 'Lymphopenia is associated with severe coronavirus disease 2019 ' '(COVID-19) infections: a systemic review and meta-analysis', 'volume': '96', 'author': 'Zhao', 'year': '2020', 'journal-title': 'Int J Infect Dis'}, { 'key': '2021013016561624000_sfaa199-B20', 'doi-asserted-by': 'crossref', 'first-page': '101663', 'DOI': '10.1016/j.tmaid.2020.101663', 'article-title': 'Clinical and microbiological effect of a combination of ' 'hydroxychloroquine and azithromycin in 80 COVID-19 patients with at ' 'least a six-day follow up: a pilot observational study', 'volume': '34', 'author': 'Gautret', 'year': '2020', 'journal-title': 'Travel Med Infect Dis'}, { 'key': '2021013016561624000_sfaa199-B21', 'doi-asserted-by': 'crossref', 'first-page': '2431', 'DOI': '10.1056/NEJMoa2006923', 'article-title': 'Renin–angiotensin–aldosterone system blockers and the risk of covid-19', 'volume': '382', 'author': 'Mancia', 'year': '2020', 'journal-title': 'N Engl J Med'}, { 'key': '2021013016561624000_sfaa199-B22', 'doi-asserted-by': 'crossref', 'first-page': '168', 'DOI': '10.1001/jama.2020.11301', 'article-title': 'Association of angiotensin-converting enzyme inhibitor or angiotensin ' 'receptor blocker use with COVID-19 diagnosis and mortality', 'volume': '324', 'author': 'Fosbøl', 'year': '2020', 'journal-title': 'JAMA'}, { 'key': '2021013016561624000_sfaa199-B23', 'doi-asserted-by': 'crossref', 'first-page': '195', 'DOI': '10.7326/M20-1515', 'article-title': 'Risks and impact of angiotensin-converting enzyme inhibitors or ' 'angiotensin-receptor blockers on SARS-CoV-2 infection in adults: a ' 'living systematic review', 'volume': '173', 'author': 'Mackey', 'year': '2020', 'journal-title': 'Ann Int Med'}, { 'key': '2021013016561624000_sfaa199-B24', 'doi-asserted-by': 'crossref', 'first-page': '1671', 'DOI': '10.1161/CIRCRESAHA.120.317134', 'article-title': 'Association of inpatient use of angiotensin converting enzyme ' 'inhibitors and angiotensin II receptor blockers with mortality among ' 'patients with hypertension hospitalized with COVID-19', 'volume': '126', 'author': 'Zhang', 'year': '2020', 'journal-title': 'Circ Res'}, { 'key': '2021013016561624000_sfaa199-B25', 'doi-asserted-by': 'crossref', 'first-page': '104927', 'DOI': '10.1016/j.phrs.2020.104927', 'article-title': 'ACEI/ARB use and risk of infection or severity or mortality of ' 'COVID-19: a systematic review and meta-analysis', 'volume': '158', 'author': 'Zhang', 'year': '2020', 'journal-title': 'Pharmacol Res'}, { 'key': '2021013016561624000_sfaa199-B26', 'doi-asserted-by': 'crossref', 'first-page': '271', 'DOI': '10.1016/j.cell.2020.02.052', 'article-title': 'SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a ' 'clinically proven protease inhibitor', 'volume': '181', 'author': 'Hoffmann', 'year': '2020', 'journal-title': 'Cell'}, { 'key': '2021013016561624000_sfaa199-B27', 'doi-asserted-by': 'crossref', 'first-page': '2096', 'DOI': '10.3390/jcm9072096', 'article-title': 'ACE2 as a therapeutic target for COVID-19; its role in infectious ' 'processes and regulation by modulators of the RAAS system', 'volume': '9', 'author': 'Michaud', 'year': '2020', 'journal-title': 'J Clin Med'}, { 'key': '2021013016561624000_sfaa199-B28', 'doi-asserted-by': 'crossref', 'first-page': '1091', 'DOI': '10.1016/j.kint.2020.04.009', 'article-title': 'Blockade of SARS-CoV-2 infection by recombinant soluble ACE2', 'volume': '97', 'author': 'Alhenc-Gelas', 'year': '2020', 'journal-title': 'Kidney Int'}, { 'key': '2021013016561624000_sfaa199-B29', 'doi-asserted-by': 'crossref', 'first-page': '714', 'DOI': '10.2215/CJN.03530320', 'article-title': 'Sound science before quick judgement regarding RAS blockade in COVID-19', 'volume': '15', 'author': 'Sparks', 'year': '2020', 'journal-title': 'Clin J Am Soc Nephrol'}, { 'key': '2021013016561624000_sfaa199-B30', 'doi-asserted-by': 'crossref', 'first-page': '586', 'DOI': '10.1007/s00134-020-05985-9', 'article-title': 'Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: ' 'molecular mechanisms and potential therapeutic target', 'volume': '46', 'author': 'Zhang', 'year': '2020', 'journal-title': 'Intensive Care Med'}], 'container-title': 'Clinical Kidney Journal', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'http://academic.oup.com/ckj/article-pdf/13/5/878/36155722/sfaa199.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'syndication'}, { 'URL': 'http://academic.oup.com/ckj/article-pdf/13/5/878/36155722/sfaa199.pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 11, 17]], 'date-time': '2022-11-17T11:17:48Z', 'timestamp': 1668683868000}, 'score': 1, 'resource': {'primary': {'URL': 'https://academic.oup.com/ckj/article/13/5/878/5934808'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 10, 1]]}, 'references-count': 30, 'journal-issue': { 'issue': '5', 'published-online': {'date-parts': [[2020, 10, 21]]}, 'published-print': {'date-parts': [[2020, 10, 1]]}}, 'URL': 'http://dx.doi.org/10.1093/ckj/sfaa199', 'relation': {}, 'ISSN': ['2048-8513'], 'subject': ['Transplantation', 'Nephrology'], 'published-other': {'date-parts': [[2020, 10]]}, 'published': {'date-parts': [[2020, 10, 1]]}}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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