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

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.

Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation

“…In agreement with findings from other series, our study shows that ICU access [ 28 , 29 ] and CKD predict mortality [ 30 , 31 ]. Interestingly, transfusion need is not higher in patients administered with prophylactic LMWH doses, therefore confirming that this scheme is safe.…”

The First Kidney Transplantation After Recipient and Living Donor Recovered From COVID-19

“…They also found that there was a substantial benefit to the recipient following living-donor kidney transplantation. In a multicenter study from Turkey, Ozturk et al [ 4 ] compared the mortality of the patients with CKD and HD and found no difference between recipients and the control group; however, patients with HD and CKD had higher mortality. Craig-Schapiro et al [ 2 ] compared the clinical results of COVID-19 in patients with waitlisted and recipients, and they showed that waitlisted patients had a higher risk for hospitalization and mortality, and declared that COVID-19 had a dramatic impact and took the patient’s opportunity for transplantation.…”

Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

“…In a meta-analysis from the US, Europe, and China, the prevalence of heart disease was 37% and CKD 27% [39] . In a multicenter study from Turkey among patients with CKD, 21.9% admitted to ICU, and 14.2% died [40] . The interactions between CKD and diabetes in COVID‐19 may render these patients highly vulnerable to death.…”