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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

Ozturk et al., Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfaa271
Dec 2020  
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Mortality 44% Improvement Relative Risk HCQ for COVID-19  Ozturk et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 1,150 patients in Turkey Lower mortality with HCQ (not stat. sig., p=0.14) c19hcq.org Ozturk et al., Nephrology Dialysis Tra.., Dec 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
Retrospective 1210 hospitalized patients in Turkey focused on chronic kidney disease, haemodialysis and renal transplant patients, but also showing lower mortality with HCQ. Subject to confounding by indication.
risk of death, 43.9% lower, RR 0.56, p = 0.14, treatment 165 of 1,127 (14.6%), control 6 of 23 (26.1%), NNT 8.7, CQ/HCQ.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ozturk et al., 4 Dec 2020, retrospective, Turkey, peer-reviewed, 71 authors.
This PaperHCQAll
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'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, '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&amp;lt;\u20090.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P\u2009' '&amp;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&amp;lt;\u2009' '0.001) and 18/450 (4%; 95% CI 2.5–6.2; P\u2009&amp;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 ' 'Turkey', 'prefix': '10.1093', 'volume': '35', 'author': [ { 'given': 'Savas', 'family': 'Ozturk', 'sequence': 'first', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Haseki ' 'Training and Research Hospital, Istanbul, Turkey'}]}, { 'given': 'Kenan', 'family': 'Turgutalp', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Faculty ' 'of Medicine, Mersin University Training and Research Hospital, ' 'Mersin, Turkey'}]}, { 'ORCID': 'http://orcid.org/0000-0002-4055-7896', 'authenticated-orcid': False, 'given': 'Mustafa', 'family': 'Arici', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Faculty of Medicine, Hacettepe ' 'University, Ankara, Turkey'}]}, { 'given': 'Ali Riza', 'family': 'Odabas', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Sultan ' '2.Abdulhamid Han Training and Research Hospital, Istanbul, ' 'Turkey'}]}, { 'given': 'Mehmet Riza', 'family': 'Altiparmak', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, ' 'Istanbul University – Cerrahpasa Cerrahpasa Faculty of Medicine, ' 'Istanbul, Turkey'}]}, { 'given': 'Zeki', 'family': 'Aydin', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Darica Farabi Training and Research ' 'Hospital, Kocaeli, Turkey'}]}, { 'given': 'Egemen', 'family': 'Cebeci', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Haseki ' 'Training and Research Hospital, Istanbul, Turkey'}]}, { 'given': 'Taner', 'family': 'Basturk', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Sisli Hamidiye Etfal Training and ' 'Research Hospital, University of Health Sciences, Istanbul, ' 'Turkey'}]}, { 'given': 'Zeki', 'family': 'Soypacaci', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Izmir ' 'Katip Celebi University, Atatürk Training and Research Hospital, ' 'Izmir, Turkey'}]}, { 'given': 'Garip', 'family': 'Sahin', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Faculty ' 'of Medicine, Eskisehir Osmangazi University, Eskisehir, ' 'Turkey'}]}, { 'given': 'Tuba', 'family': 'Elif Ozler', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, ' 'University of Health Sciences, Kanuni Sultan Suleyman Training ' 'and Research Hospital, Istanbul, Turkey'}]}, { 'given': 'Ekrem', 'family': 'Kara', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Faculty ' 'of Medicine, Recep Tayyip Erdogan University, Rize, Turkey'}]}, { 'given': 'Hamad', 'family': 'Dheir', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Sakarya ' 'University Training and Research Hospital, Sakarya, Turkey'}]}, { 'given': 'Necmi', 'family': 'Eren', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Faculty of Medicine, Kocaeli ' 'University, Kocaeli, Turkey'}]}, { 'given': 'Gultekin', 'family': 'Suleymanlar', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Faculty ' 'of Medicine, Akdeniz University, Antalya, Turkey'}]}, { 'ORCID': 'http://orcid.org/0000-0003-1284-916X', 'authenticated-orcid': False, 'given': 'Mahmud', 'family': 'Islam', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Zonguldak Ataturk State Hospital, ' 'Zonguldak, Turkey'}]}, { 'given': 'Melike Betul', 'family': 'Ogutmen', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, ' 'Haydarpasa Numune Training and Research Hospital, Istanbul, ' 'Turkey'}]}, { 'given': 'Erkan', 'family': 'Sengul', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Kocaeli ' 'Derince Training and Research Hospital, Kocaeli, Turkey'}]}, { 'given': 'Yavuz', 'family': 'Ayar', 'sequence': 'additional', 'affiliation': [{'name': 'Department of Nephrology, Bursa City Hospital, Bursa, Turkey'}]}, { 'given': 'Murside Esra', 'family': 'Dolarslan', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Trabzon ' 'Kanuni Training and Research Hospital, Trabzon, Turkey'}]}, { 'given': 'Serkan', 'family': 'Bakirdogen', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, ' 'Canakkale Onsekiz Mart University, Canakkale, Turkey'}]}, { 'given': 'Seda', 'family': 'Safak', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, ' 'Istanbul University Faculty of Medicine, Istanbul, Turkey'}]}, { 'given': 'Ozkan', 'family': 'Gungor', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Kahramanmaras Sutcu Imam University ' 'Faculty of Medicine, Kahramanmaras, Turkey'}]}, { 'given': 'Idris', 'family': 'Sahin', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Inonu ' 'University Faculty of Medicine, Turgut Ozal Medical Center, ' 'Malatya, Turkey'}]}, { 'given': 'Ilay Berke', 'family': 'Mentese', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Marmara ' 'University Faculty of Medicine, Marmara University Pendik ' 'Training and Research Hospital, Istanbul, Turkey'}]}, { 'given': 'Ozgur', 'family': 'Merhametsiz', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Yeni ' 'Yuzyil University Faculty of Medicine, Istanbul, Turkey'}]}, { 'given': 'Ebru Gok', 'family': 'Oguz', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Diskapi ' 'Yildirim Beyazit Training and Research Hospital, Ankara, ' 'Turkey'}]}, { 'given': 'Dilek Gibyeli', 'family': 'Genek', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Mugla ' 'Sitki Kocman University Faculty of Medicine, Training and ' 'Research Hospital, Mugla, Turkey'}]}, { 'given': 'Nadir', 'family': 'Alpay', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, ' 'Memorial Hizmet Hospital, Istanbul, Turkey'}]}, { 'given': 'Nimet', 'family': 'Aktas', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Bursa ' 'Higher Specialization Training and Research Hospital, Bursa, ' 'Turkey'}]}, { 'given': 'Murat', 'family': 'Duranay', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, Ankara ' 'Training and Research Hospital, Ankara, Turkey'}]}, { 'given': 'Selma', 'family': 'Alagoz', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, ' 'University of Health Sciences, Bagcilar Training and Research ' 'Hospital, Istanbul, Turkey'}]}, { 'given': 'Hulya', 'family': 'Colak', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, ' 'University of Health Sciences, Training and Research Hospital, ' 'Izmir, Turkey'}]}, { 'given': 'Zelal', 'family': 'Adibelli', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Faculty ' 'of Medicine, Usak University, Usak, Turkey'}]}, { 'given': 'Irem', 'family': 'Pembegul', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Malatya Training and Research ' 'Hospital, Malatya, Turkey'}]}, { 'given': 'Ender', 'family': 'Hur', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Manisa Merkezefendi State Hospital, ' 'Manisa, Turkey'}]}, { 'given': 'Alper', 'family': 'Azak', 'sequence': 'additional', 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'affiliation': [ { 'name': 'Department of Nephrology, University of Health Sciences, ' 'Diyarbakır Gazi Yasargil Training and Research Hospital, ' 'Diyarbakir, Turkey'}]}, { 'given': 'Engin', 'family': 'Onan', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Adana City Training and Research ' 'Hospital, Adana, Turkey'}]}, { 'given': 'Kultigin', 'family': 'Turkmen', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Necmettin Erbakan University Meram ' 'Faculty of Medicine, Konya, Turkey'}]}, { 'ORCID': 'http://orcid.org/0000-0002-2229-5140', 'authenticated-orcid': False, 'given': 'Nuri Baris', 'family': 'Hasbal', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Nephrology, Hakkari State Hospital, Hakkari, ' 'Turkey'}]}, { 'given': 'Ali', 'family': 'Gurel', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Division of Nephrology, Firat ' 'University Faculty of Medicine, 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Late treatment
is less effective
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