Mortality analysis of COVID-19 infection in chronic kidney disease,

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.

C1 [Ozturk, Savas; Cebeci, Egemen] Univ Hlth Sci, Haseki Training & Res Hosp, Dept Nephrol, Istanbul, Turkey.

[Turgutalp, Kenan] Mersin Univ Training & Res Hosp, Fac Med, Dept Internal Med, Div Nephrol, Mersin, Turkey.

[Arici, Mustafa] Hacettepe Univ, Fac Med, Dept Nephrol, Ankara, Turkey.

[Odabas, Ali Riza; Gok, Mahmut] Univ Hlth Sci, Sultan 2 Abdulhamid Han Training & Res Hosp, Dept Nephrol, Istanbul, Turkey.

[Altiparmak, Mehmet Riza; Seyahi, Nurhan] Istanbul Univ Cerrahpasa, Dept Internal Med, Div Nephrol, Cerrahpasa Fac Med, Istanbul, Turkey.

[Aydin, Zeki] Darica Farabi Training & Res Hosp, Dept Nephrol, Kocaeli, Turkey.

[Basturk, Taner; Sevinc, Mustafa] Univ Hlth Sci, Sisli Hamidiye Etfal Training & Res Hosp, Dept Nephrol, Istanbul, Turkey.

[Soypacaci, Zeki] Izmir Katip Celebi Univ, Ataturk Training & Res Hosp, Dept Internal Med, Div Nephrol, Izmir, Turkey.

[Sahin, Garip; Ozkurt, Sultan] Eskisehir Osmangazi Univ, Fac Med, Dept Internal Med, Div Nephrol, Eskisehir, Turkey.

[Ozler, Tuba Elif] Univ Hlth Sci, Kanuni Sultan Suleyman Training & Res Hosp, Dept Internal Med, Div Nephrol, Istanbul, Turkey.

[Kara, Ekrem] Recep Tayyip Erdogan Univ, Fac Med, Dept Internal Med, Div Nephrol, Rize, Turkey.

[Dheir, Hamad] Sakarya Univ Training & Res Hosp, Dept Internal Med, Div Nephrol, Sakarya, Turkey.

[Eren, Necmi; Bek, Sibel Gokcay] Kocaeli Univ, Fac Med, Dept Nephrol, Kocaeli, Turkey.

[Suleymanlar, Gultekin; Bora, Feyza] Akdeniz Univ, Fac Med, Dept Internal Med, Div Nephrol, Antalya, Turkey.

[Islam, Mahmud] Zonguldak Ataturk State Hosp, Dept Nephrol, Zonguldak, Turkey.

[Ogutmen, Melike Betul; Demirelli, Bulent] Univ Hlth Sci, Haydarpasa Numune Training & Res Hosp, Dept Nephrol, Istanbul, Turkey.

[Sengul, Erkan] Univ Hlth Sci, Kocaeli Derince Training & Res Hosp, Dept Nephrol, Kocaeli, Turkey.

[Ayar, Yavuz] Bursa City Hosp, Dept Nephrol, Bursa, Turkey.

[Dolarslan, Murside Esra] Univ Hlth Sci, Trabzon Kanuni Training & Res Hosp, Dept Nephrol, Trabzon, Turkey.

[Bakirdogen, Serkan] Canakkale Onsekiz Mart Univ, Dept Internal Med, Div Nephrol, Canakkale, Turkey.

[Safak, Seda; Oto, Ozgur Akin; Yildiz, Alaattin] Istanbul Univ, Dept Internal Med, Div Nephrol, Fac Med, Istanbul, Turkey.

[Gungor, Ozkan; Altunoren, Orcun] Kahramanmaras Sutcu Imam Univ, Dept Nephrol, Fac Med, Kahramanmaras, Turkey.

[Sahin, Idris] Inonu Univ, Turgut Ozal Med Ctr, Dept Internal Med, Div Nephrol,Fac Med, Malatya, Turkey.

[Mentese, Ilay Berke; Tuglular, Serhan Zubeyde] Marmara Univ, Marmara Univ Pendik Training & Res Hosp, Dept Internal Med, Div Nephrol,Fac Med, Istanbul, Turkey.

[Merhametsiz, Ozgur; Demir, Mehmet Emin] Yeni Yuzyil Univ, Dept Internal Med, Div Nephrol, Fac Med, Istanbul, Turkey.

[Oguz, Ebru Gok; Ayli, Mehmet Deniz] Univ Hlth Sci, Diskapi Yildirim Beyazit Training & Res Hosp, Dept Nephrol, Ankara, Turkey.

[Genek, Dilek Gibyeli; Huddam, Bulent] Mugla Sitki Kocman Univ, Training & Res Hosp, Dept Internal Med, Div Nephrol,Fac Med, Mugla, Turkey.

[Alpay, Nadir] Mem Hizmet Hosp, Dept Internal Med, Div Nephrol, Istanbul, Turkey.

[Aktas, Nimet] Univ Hlth Sci, Bursa Higher Specializat Training & Res Hosp, Dept Nephrol, Bursa, Turkey.

[Duranay, Murat; Bakar, Betul] Univ Hlth Sci, Ankara Training & Res Hosp, Dept Nephrol, Ankara, Turkey.

[Alagoz, Selma] Univ Hlth Sci, Bagcilar Training & Res Hosp, Dept Internal Med, Div Nephrol, Istanbul, Turkey.

[Colak, Hulya] Univ Hlth Sci, Training & Res Hosp, Dept Internal Med, Div Nephrol, Izmir, Turkey.

[Adibelli, Zelal] Usak Univ, Fac Med, Dept Internal Med, Div Nephrol, Usak, Turkey.

[Pembegul, Irem] Malatya Training & Res Hosp, Dept Nephrol, Malatya, Turkey.

[Hur, Ender] Manisa Merkezefendi State Hosp, Dept Nephrol, Manisa, Turkey.

[Azak, Alper] Balikesir Ataturk City Hosp, Dept Nephrol, Balikesir, Turkey.

[Taymez, Dilek Guven] Kocaeli State Hosp, Dept Nephrol, Kocaeli, Turkey.

[Tatar, Erhan; Bozaci, Ilter] Univ Hlth Sci, Izmir Bozyaka Training & Res Hosp, Dept Nephrol, Izmir, Turkey.

[Kazancioglu, Rumeyza; Gursu, Meltem] Bezmialem Vakif Univ, Dept Internal Med, Div Nephrol, Fac Med, Istanbul, Turkey.

[Oruc, Aysegul] Bursa Uludag Univ, Dept Nephrol, Fac Med, Bursa, Turkey.

[Yuksel, Enver] Univ Hlth Sci, Diyarbakir Gazi Yasargil Training & Res Hosp, Dept Nephrol, Diyarbakir, Turkey.

[Onan, Engin; Tonbul, Halil Zeki] Adana City Training & Res Hosp, Dept Nephrol, Adana, Turkey.

[Turkmen, Kultigin] Necmettin Erbakan Univ, Dept Nephrol, Meram Fac Med, Konya, Turkey.

[Hasbal, Nuri Baris] Hakkari State Hosp, Dept Nephrol, Hakkari, Turkey.

[Gurel, Ali] Firat Univ, Dept Internal Med, Div Nephrol, Fac Med, Elazig, Turkey.

[Yelken, Berna] Koc Univ Hosp, Dept Transplantat, Istanbul, Turkey.

[Sahutoglu, Tuncay] Univ Hlth Sci, Mehmet Akif Inan Training & Res Hosp, Dept Nephrol, Sanliurfa, Turkey.

[Sipahi, Savas] Sakarya Univ, Training & Res Hosp, Dept Internal Med, Div Nephrol,Fac Med, Sakarya, Turkey.

[Tanrisev, Mehmet] Univ Hlth Sci, Tepecik Training & Res Hosp, Dept Internal Med, Div Nephrol, Izmir, Turkey.

[Tokgoz, Bulent] Erciyes Univ, Dept Nephrol, Fac Med, Kayseri, Turkey.

[Sezer, Siren] Atilim Univ, Dept Internal Med, Div Nephrol, Fac Med, Istanbul, Turkey.

[Ates, Kenan] Ankara Univ, Dept Internal Med, Div Nephrol, Fac Med Ankara, Ankara, Turkey.