Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and ...determinants of mortality in a large group of MHD patients hospitalized for COVID-19.
This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis.
Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 57-74 vs. 63 52-71 years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 10
per mm
versus 192 × 10
per mm
, p = 0.011) and lymphocyte (800 per mm
versus 1000 per mm
, p < 0.001) counts and albumin levels (median, 3.2 g/dl versus 3.5 g/dl, p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 95% CI, 1.003-1.041, p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 95% CI, 2.168-17.863, p < 0.001), presence of congestive heart failure (HR: 2.247 95% CI, 1.228-4.111, p = 0.009), ferritin levels on admission (HR; 1.057 95% CI, 1.006-1.111, p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 95% CI, 2.143-7.132, p < 0.001) and low platelet count (< 150 × 10
per mm
) during hospitalization (HR; 1.864 95% CI, 1.025-3.390, p = 0.041) were risk factors for mortality.
Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.
Purpose: This study aimed to examine the quality of life (QOL) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Additionally, associations between QOL and clinical and demographic factors ...were investigated.Materials and Methods: Patients under dialysis treatment were included in this cross-sectional study. Demographic data, disease history, and laboratory data were collected. Charlson comorbidity index (CCl) was used to score the level of comorbidity. Health-related quality of life (HRQOL) was measured by Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL-SF 1.3).Results: One hundred and five patients, 60 of whom were under HD, and 45 were under PD (45.7% were females; mean age 54.63±13.86 years) were enrolled in the study. PD patients had better scores in five domains of the KDQOL-SF 1.3 questionnaire (emotional role, work status, cognitive function, dialysis staff encouragement, patient satisfaction). Older age, female sex, lower education level, high comorbidity score and, hospitalization in the last 12 months were found to be related to low QOL. We detected positive correlations between serum hemoglobin levels, albumin, and some subgroups of KDQOL-SF 1.3 scale; whereas negative correlations were detected between serum ferritin levels and some of the KDQOL-SF 1.3 items. Conclusion: According to our study, HRQOL was better in PD patients compared to HD in specific domains of the KDQOL-SF 1.3. Age, gender, education level, hemoglobin level, albumin, and ferritin were associated with HRQOL.
Amaç: Bu çalışmanın amacı hemodiyaliz (HD) ve periton diyalizi (PD) hastalarında yaşam kalitesini incelemektir. Ayrıca, yaşam kalitesi ile klinik ve demografik faktörler arasındaki ilişkiler incelenmiştir.Gereç ve Yöntem: Diyaliz tedavisi alan hastalar bu kesitsel çalışmaya dahil edildi. Demografik veriler, hastalık öyküsü, laboratuvar verileri toplandı. Komorbidite seviyesini puanlamak için Charlson komorbidite indeksi (CCl) kullanıldı. Sağlıkla ilişkili yaşam kalitesi (SYK), Böbrek Hastalığı İlişkili Yaşam Kalitesi Kısa Form Versiyon 1.3 (KDQOL-SF 1.3) ile ölçülmüştür.Bulgular: Çalışmaya 60'ı HD, 45'i PD tedavisi altında (% 45.7'si kadın; ort. yaş 54.63 ± 13.86) toplam 105 hasta alındı. PD hastaları beş alanda KDQOL-SF 1.3 alt ölçek puanları (duygusal rol, iş durumu, bilişsel işlev, diyaliz personelinin teşviki, hasta memnuniyeti) HD hastalarına göre daha yüksek puanlara sahipti. İleri yaş, kadın cinsiyet, düşük eğitim düzeyi, yüksek komorbidite skoru ve son 12 aydaki hastanede yatış sürelerinin yaşam kalitesi ile ilişkili olduğu bulundu. Bazı KDQOL-SF 1.3 alt ölçekleri ile hemoglobin, albümin arasında pozitif; ferritin düzeyleri arasında negatif korelasyonlar olduğu tespit edildi.Sonuç: Çalışmamıza göre, SYK, PD hastalarında HD hastalarına göre, KDQOL-SF 1.3'ün spesifik alanlarında daha iyiydi. Yaş, cinsiyet, eğitim düzeyi, hemoglobin, albümin ve ferritin düzeyleri SYK ile ilişkiliydi.
We aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19.
We conducted a multicenter, retrospective ...study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission.
One hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl 2.9-3.8 vs. 3.8 g/dl 3.5-4.1, p = 0.002), higher serum ferritin (679 μg/L 184-2260 vs. 331 μg/L 128-839, p = 0.048), and lower lymphocyte counts (700/μl 460-950 vs. 860 /μl 545-1385, p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis.
Over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.
Purpose
Cytomegalovirus infection is an important complication in immunocompromised patients. As few studies have shown that cyclophosphamide treatment is a risk factor for cytomegalovirus infection ...in patients with glomerulonephritis, we aimed to describe the frequency and risk factors of cytomegalovirus infection in glomerulonephritis patients treated with cyclophosphamide.
Methods
We prospectively recruited 43 cytomegalovirus seropositive patients with glomerulonephritis treated with cyclophosphamide. We screened all patients for viral DNA monthly during treatment. Patients were compared for age, sex, glomerular pathology, renal function and clinical status regarding development of cytomegalovirus infection before and after the treatment.
Results
Cytomegalovirus infection was detected in 10 (23.3%) patients, most commonly within the first 2 months of cyclophosphamide treatment. All patients recovered without any cytomegalovirus-related complications. Patients with cytomegalovirus infection had higher serum creatinine (4.2 ± 3.2 vs. 1.9 ± 1.8 mg/dl,
p
= 0.006) and lower estimated glomerular filtration rate (29 ± 11 vs. 65 ± 8 ml/min/1.73 m
2
,
p
= 0.016) at diagnosis compared with cytomegalovirus infection non-occurred patients. In addition, number of patients presented with rapidly progressive glomerulonephritis were higher in cytomegalovirus infection group (80.0% vs. 27.3%,
p
= 0.007). Moreover, cytomegalovirus infection was associated with prolonged hospital stay (54 ± 7 vs. 29 ± 6 days,
p
= 0.027).
Conclusion
Cytomegalovirus infection is a common complication in glomerulonephritis patients treated with cyclophosphamide in this prospective study. Routine monitoring and prophylaxis should be considered for these high-risk patients.
Abstract
Background and Aims
Diabetes mellitus (DM) is the most common cause of chronic kidney disease (CKD) 1. The prevalence of CKD is therefore increasing worldwide with increasing prevalence of ...DM 1. Among those with DM, CKD prevalence varies widely between countries. The actual prevalence of CKD in patients with DM in Turkey is unknown. This study aimed to determine frequency of CKD among diabetic patients of Cappadocia cohort and patients’ awareness about the disease.
Method
A total of 1591 diabetic patients from the Cappadocia cohort were invited to this cross-sectional study. A trained study team administered a questionnaire for patients’ medical history, knowledge, attitudes, and awareness of the disease and measured patients’ blood pressures (BPs) at least three times using an automated device. Serum creatinine was measured and spot urine albumin/creatinine ratio (ACR) measurements were performed for three consecutive days. A diagnosis of CKD was established if glomerular filtration rate (GFR)is <60 mL/min or ACR is >30 mg/g.
Results
The mean age of the patients was 63±10 years. Overall, 60.9% patients were obese (body mass index ≥30 kg/m2), and 70% patients were hypertensive. HbA1c was analyzed in 98.2% of the patients; HbA1c was <7% in 27.4%, ≥7%-≤8% in 20.8%, >8%-≤9% in 17.7%, and >9% in 34.1% of the patients. of 1535 patients with blood and urine analyses, 231 of 1008 (22.9%) females and 154 of 527 (29.2%) males had CKD (P = .007). Among patients with GFR values, 11.4% had a GFR of <60 mL/min and 88.6% had a GFR of ≥60 mL/min. Among 1544 patients with ACR measurements, 18.2% had values ≥30 mg/g and 4.4% had values ≥300 mg/g. CKD was detected in 385 (25.1%) of 1535 patients with both GFR and ACR values (Figure 1). of these patients, 28.1% had Stage 1, 25.7% had Stage 2, 32.5% had Stage 3A, 11.2% had Stage 3B and 2.6% had Stage 4 or 5 CKD. Excluding two patients with missing data, 36 of 383 CKD patients (9.4%) knew that they had CKD. In the logistic regression analysis, old age (OR=1.05, 95% CI 1.03-1.07; p<0.001), male sex (OR=2.11, 95% CI 1.43-3.12; p<0.001), duration of DM (OR=1.03, 95% CI 1.00-1.05; P = .022), morbid obesity (OR=3.58, 95% CI 1.28-10.03, P = .015), a CRP level of >5 mg/L (OR=1.60, 95% CI 1.12-2.27; P = .009), a triglyceride level of ≥150 mg/L (OR=1.74, 95% CI 1.24-2.45; P = .002), and grade 3 hypertension (OR=2.13, 95% CI 1.02-4.44; P = .043) were found to be significantly associated with an increased risk of CKD in patients with DM.
Conclusion
In the present study, CKD prevalence among diabetic patients in Turkey was 25.1%. Overall, 53.8% of the patients with CKD had a GFR of ≥60 mL/min although they had an ACR of ≥30 mg/day; that is, if albuminuria was not studied, this subgroup of patients would have been considered to have normal kidney function according to GFR. The awareness of CKD was found to be quite low in the patients. Therefore, periodic screening of diabetic patients should always include urinalysis, particularly ACR, as well as serum creatinine, fasting blood glucose and HbA1c.
Abstract
Background and Aims
Coronavirus Disease-19 (COVID-19) pandemic has currently been one of the leading causes of psychosocial stress worldwide. We hypothesized that possible changes in anxiety ...status might affect blood pressure in haemodialysis (HD) patients during COVID-19 pandemic.
Method
Seventy one prevalent HD patients were included in this prospective study. Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI) were applied to assess psychological status of the patients. Peridialysis blood pressure measurements were performed and average of 6 consecutive HD sessions’ pre-dialysis systolic blood pressure measurements were used for statistical analyses. All assessments were performed both at the beginning (March) and after ending (June) of the partial lock-down, which was officially instituted by the Government in parallel with the status of the pandemic in Turkey.
Results
Mean age (±SD) was 59.2±14.8 years and 52% of the patients were female. Dose of medications including antihypertensives, dry weight, interdialytic weight gain, and Kt/Vurea were stable during the study period. STAI-state score was higher in March than that in June (44.6±12.6 vs 42.3±11.5, respectively, p=0.047), whereas HADS-anxiety, HADS-depression, and STAI-trait scores were not different. Pre-dialysis systolic blood pressure was significantly higher in March than in June (127.9±20.3 vs 124.8±22.8 mmHg, respectively, p=0.029). Change in state anxiety score from March to June was remarkable particularly in patients not taking a beta-blocker (49.3±9.6 to 43.8±11.1, p=0.001) and in patients younger than the median age of 64 years (48.6±12.8 to 45.3±12.5, p=0.029). Change in blood pressure level from March to June was found to be significant only in patients not taking a beta-blocker (123.4±20.2 to 118.2±20.6 mmHg, p<0.001), while did not reach a statistically significant level in the others.
Conclusion
Our findings, though need to be confirmed by further studies, revealed an association between a higher state of anxiety and a higher blood pressure level in HD patients in COVID-19 pandemic era, which was remarkable particularly in patients not taking a beta-blocker.
Both hepatitis C virus infection (HCV) and chronic kidney disease (CKD) have been comorbid illnesses with increasing morbidity and mortality. The present study was conducted to present real-life ...experiences about treatment of HCV and CKD with a fixed-dose combination of paritaprevir 150 mg/day, ritonavir 100 mg/day as a booster, ombitasvir 25 mg/day, and dasabuvir 250 mg twice/day, the PROD regimen.
This was a multicenter, retrospective cohort study. Seventy-five patients with both HCV and CKD were treated with a PROD-based regimen with or without ribavirin. Fifty-three of 75 patients were on maintenance hemodialysis program. Seven patients had compensated liver cirrhosis. The patients with genotype 1a or compensated liver cirrhosis were treated with the PROD regimen and ribavirin in a dose of 200 mg every other day for 12 weeks. The patients with genotype 1b were treated with PROD for 12 weeks. The patients with genotype 4 were treated with a combination of paritaprevir, ritonavir, ombitasvir, and ribavirin 200 mg every other day.
All patients except one were HCV-RNA negative (98.6%) at the end of treatment. One patient had decompensated after the fourth day of therapy. She stopped the treatment, and she was exitus after 2 months. Two patients died of reasons not related to the drugs 2 months after negativity of HCV-RNA. Sustained viral rate 12 weeks after treatment was found in 96% of the patients.
The PROD regimen was very effective and safe for treatment in patients with HCV and CKD who were in stages 4 and 5.
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