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.
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.
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DOI：
10.1093/ndt/gfaa271
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发表时间：
2020-12-04
期刊：
影响因子：
--
通讯作者：
Ates K
中科院分区：
文献类型：
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作者：
Ozturk S;Turgutalp K;Arici M;Odabas AR;Altiparmak MR;Aydin Z;Cebeci E;Basturk T;Soypacaci Z;Sahin G;Elif Ozler T;Kara E;Dheir H;Eren N;Suleymanlar G;Islam M;Ogutmen MB;Sengul E;Ayar Y;Dolarslan ME;Bakirdogen S;Safak S;Gungor O;Sahin I;Mentese IB;Merhametsiz O;Oguz EG;Genek DG;Alpay N;Aktas N;Duranay M;Alagoz S;Colak H;Adibelli Z;Pembegul I;Hur E;Azak A;Taymez DG;Tatar E;Kazancioglu R;Oruc A;Yuksel E;Onan E;Turkmen K;Hasbal NB;Gurel A;Yelken B;Sahutoglu T;Gok M;Seyahi N;Sevinc M;Ozkurt S;Sipahi S;Bek SG;Bora F;Demirelli B;Oto OA;Altunoren O;Tuglular SZ;Demir ME;Ayli MD;Huddam B;Tanrisev M;Bozaci I;Gursu M;Bakar B;Tokgoz B;Tonbul HZ;Yildiz A;Sezer S;Ates K
慢性肾脏疾病和免疫抑制，如肾移植(RT)，是已确定的2019年严重冠状病毒病的潜在风险因素之一(新冠肺炎)。在慢性肾脏病、血液透析(HD)和RT患者中，任何类型感染的发病率和死亡率都比普通人群高得多。一项比较新冠肺炎在中晚期慢性肾脏病(3-5期)、HD和RT患者与对照组患者预后的大型研究仍然缺乏。我们进行了一项多中心、回顾性、观察性研究，涉及土耳其47个中心的住院成年新冠肺炎患者。将慢性肾功能衰竭3~5期、慢性肾功能衰竭和慢性肾功能衰竭患者与无肾脏疾病的新冠肺炎患者进行比较。比较了人口学、合并症、药物、实验室测试、新冠肺炎治疗和结果[住院死亡率和综合住院结果死亡率或住进重症监护病房]。入选患者1210例，中位年龄61岁(四分位数3 48~71岁)，女性551例(45.5%)，包括对照组(n=450)、HD组(n=390)、RT组(n=81)和CKD组(n=289)。ICU住院率为266/1210(22.0%)。死亡172/1210例(14.2%)。慢性肾脏病组的ICU住院率和住院死亡率显著高于其他两组：HD=99/390(25.4%；95%CI 21.3~29.9；P <； 0.001)和63/390(16.2%；95%CI 13.0~20.4；P <；P 0.001)；RT=17/81(21.0%；95%CI13.2-30.8；P=0.002)和9/81(11.1%；95%CI5.7-19.5；P=0.001)；对照组=36/450%(8.0%；95%CI5.8-10.8；P <； 0.001)和18/450(4%；95%CI2.5-6.2；P <； 0.001)。CKD组和HD组的校正死亡率和校正综合预后显著高于对照组[危险比(95%CI)：2.88(1.5~5.44)；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)，但与对照组比较差异无统计学意义[HR(95%CI)1.89(0.76~4.72)；P=0.169；1.87(0.81~4.28)；P=0.138]。住院的新冠肺炎肾病患者，包括3-5期慢性肾脏病、HD和RT，死亡率显著高于无肾脏疾病的患者。3-5期CKD患者的住院死亡率与HD患者一样高，这可能部分是因为年龄和共病负担相似。由于这项研究中RT患者的样本量相对较小，我们无法评估RT患者是否存在增加住院死亡率的风险。
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. 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. 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]. 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.
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影响因子：
19.6
作者：
Cheng, Yichun;Luo, Ran;Xu, Gang
通讯作者：
Xu, Gang
DOI：
10.1111/ajt.15929
发表时间：
2020-07
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
通讯作者：
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影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
影响因子：
13.6
作者：
Foley, RN;Murray, AM;Collins, AJ
通讯作者：
Collins, AJ
影响因子：
8.8
作者：
Dominguez-Gil, Beatriz;Coll, Elisabeth;Hernandez, Domingo
通讯作者：
Hernandez, Domingo