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
Savas Ozturk, Kenan Turgutalp, Mustafa Arici, Ali Riza Odabas, Mehmet Riza Altiparmak, Zeki Aydin, Egemen Cebeci, Taner Basturk, Zeki Soypacaci, Garip Sahin, Tuba Elif Ozler, Ekrem Kara, Hamad Dheir, Necmi Eren, Gultekin Suleymanlar, Mahmud Islam, Melike Betul Ogutmen, Erkan Sengul, Yavuz Ayar, Murside Esra Dolarslan, Serkan Bakirdogen, Seda Safak, Ozkan Gungor, Idris Sahin, Ilay Berke Mentese, Ozgur Merhametsiz, Ebru Gok Oguz, Dilek Gibyeli Genek, Nadir Alpay, Nimet Aktas, Murat Duranay, Selma Alagoz, Hulya Colak, Zelal Adibelli, Irem Pembegul, Ender Hur, Alper Azak, Dilek Guven Taymez, Erhan Tatar, Rumeyza Kazancioglu, Aysegul Oruc, Enver Yuksel, Engin Onan, Kultigin Turkmen, Nuri Baris Hasbal, Ali Gurel, Berna Yelken, Tuncay Sahutoglu, Mahmut Gok, Nurhan Seyahi, Mustafa Sevinc, Sultan Ozkurt, Savas Sipahi, Sibel Gokcay Bek, Feyza Bora, Bulent Demirelli, Ozgur Akin Oto, Orcun Altunoren, Serhan Zubeyde Tuglular, Mehmet Emin Demir, Mehmet Deniz Ayli, Bulent Huddam, Mehmet Tanrisev, Ilter Bozaci, Meltem Gursu, Betul Bakar, Bulent Tokgoz, Halil Zeki Tonbul, Alaattin Yildiz, Siren Sezer, Kenan Ates
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfaa271
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 ¼ 450), HD (n ¼ 390), RT (n ¼ 81) and CKD (n ¼ 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 ¼ 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 ¼ 17/81 (21.0%; 95% CI 13.2-30.8; P ¼ 0.002) and 9/81 (11.1%; 95% CI 5.7-19.5; P ¼ 0.001); and control ¼ 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 ¼ 0.001; 2.44 (1.35-4.40); P ¼ 0.003; HD: 2.32 (1.21-4.46); P ¼ 0.011; 2.25 (1.23-4.12); P ¼ 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 ¼ 0.169; 1.87 (0.81-4.28); P ¼ 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.
F U N D I N G The study was funded by Turkish Society of Nephrology.
C O N F L I C T O F I N T E R E S T S T A T E M E N T The authors have no conflicts of interest to declare.
R E F E R E N C E S
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{ 'indexed': {'date-parts': [[2024, 3, 27]], 'date-time': '2024-03-27T09:32:11Z', 'timestamp': 1711531931423},
'reference-count': 36,
'publisher': 'Oxford University Press (OUP)',
'issue': '12',
'license': [ { 'start': { 'date-parts': [[2020, 12, 4]],
'date-time': '2020-12-04T00:00:00Z',
'timestamp': 1607040000000},
'content-version': 'vor',
'delay-in-days': 3,
'URL': 'http://creativecommons.org/licenses/by-nc/4.0/'}],
'funder': [ { 'DOI': '10.13039/501100004413',
'name': 'Turkish Society of Nephrology',
'doi-asserted-by': 'publisher'}],
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'published-print': {'date-parts': [[2020, 12, 4]]},
'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec>\n'
' <jats:title>Background</jats:title>\n'
' <jats:p>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.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Methods</jats:title>\n'
' <jats:p>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.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>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\u2009&lt;\u20090.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P\u2009'
'&lt;\u20090.001); 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\u2009&lt;\u2009'
'0.001) and 18/450 (4%; 95% CI 2.5–6.2; P\u2009&lt;\u20090.001). 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].</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Conclusions</jats:title>\n'
' <jats:p>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.</jats:p>\n'
' </jats:sec>',
'DOI': '10.1093/ndt/gfaa271',
'type': 'journal-article',
'created': {'date-parts': [[2020, 10, 7]], 'date-time': '2020-10-07T03:36:53Z', 'timestamp': 1602041813000},
'page': '2083-2095',
'source': 'Crossref',
'is-referenced-by-count': 134,
'title': 'Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal '
'transplant patients compared with\xa0patients without kidney disease: a nationwide analysis from '
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{ 'given': 'Gultekin',
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'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, '
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{ 'given': 'Erkan',
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{ 'given': 'Yavuz',
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{ 'given': 'Murside Esra',
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{ 'given': 'Ozkan',
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{ 'given': 'Ozgur',
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{ 'given': 'Ebru Gok',
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{ 'given': 'Dilek Gibyeli',
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{ 'given': 'Nadir',
'family': 'Alpay',
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{ 'given': 'Nimet',
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{ 'given': 'Murat',
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{ 'given': 'Selma',
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'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, '
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'Hospital, Istanbul, Turkey'}]},
{ 'given': 'Hulya',
'family': 'Colak',
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{ 'given': 'Zelal',
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'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Faculty '
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{ 'given': 'Irem',
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'affiliation': [ { 'name': 'Department of Nephrology, Malatya Training and Research '
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{ 'given': 'Ender',
'family': 'Hur',
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'affiliation': [ { 'name': 'Department of Nephrology, Manisa Merkezefendi State Hospital, '
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{ 'given': 'Alper',
'family': 'Azak',
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'affiliation': [ { 'name': 'Department of Nephrology, Balıkesir Ataturk City Hospital, '
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{ 'given': 'Dilek Guven',
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'affiliation': [ { 'name': 'Department of Nephrology, Kocaeli State Hospital, Kocaeli, '
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{ 'given': 'Erhan',
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'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Izmir '
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{ 'given': 'Rumeyza',
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{ 'given': 'Engin',
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{ 'given': 'Kultigin',
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{ 'ORCID': 'http://orcid.org/0000-0002-2229-5140',
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'given': 'Nuri Baris',
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{ 'given': 'Ali',
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'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Firat '
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{ 'given': 'Berna',
'family': 'Yelken',
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{ 'given': 'Mahmut',
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{ 'given': 'Nurhan',
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