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.
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•The preparation of peripheral thymoxy and chloride substituted phthalocyanines.•The characterizations of starting compound and phthalocyanines.•Study of electrochemical and ...spectroelectrochemical properties of phthalocyanines.•Investigation of electrocatalytic performances of the phthalocyanines.
Novel CoPc, CuPc, Fe(OAc)Pc and Mn(Cl)Pc were synthesized by using original 4-chloro-5-(2-isopropyl-5-methylphenoxy)phthalonitrile in order to investigate their potential redox applications suitable with their chemical and physical characteristics. The molecular structures of new compounds were determined with spectroscopic methods such as elemental analysis, FT-IR, UV–vis, NMR and MALDI TOF MS. Redox behaviours of Fe(OAc)Pc and Mn(Cl)Pc complexes have been probed by using diverse voltammetric techniques such as cyclic (CV) and square wave voltammetry (SWV). In addition, the colour alterations accompanying spectral changes were perused concurrently with electrocolorimetric measurements, and electrocatalytic efficiencies of the all compounds were perused in oxygen reduction reaction.
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.
Objective
Older adults with co‐morbidities have been reported to be at higher risk for adverse outcomes of coronavirus disease 2019 (COVID‐19). The characteristics of COVID‐19 in older patients and ...its clinical outcomes in different kidney disease groups are not well known.
Methods
Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between 17 April 2020 and 31 December 2020. Hospitalised patients aged 18 years or older with confirmed COVID‐19 diagnosis suffering from stage 3‐5 chronic kidney disease (CKD) or on maintenance haemodialysis (HD) treatment were included in the database. Non‐uraemic hospitalised patients with COVID‐19 were also included as the control group.
Results
We included 879 patients 388 (44.1%) female, median age: 63 (IQR: 50‐73) years. The percentage of older patients in the CKD group was 68.8% (n = 188/273), in the HD group was 49.0% (n = 150/306) and in the control group was 30.4% (n = 70/300). Co‐morbidities were higher in the CKD and HD groups. The rate of presentation with severe‐critical disease was higher in the older CKD and HD groups (43.6%, 55.3% and 16.1%, respectively). Among older patients, the intensive care unit (ICU) admission rate was significantly higher in the CKD and HD groups than in the control group (38.8%, 37.3% and 15.7%, respectively). In‐hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD groups (26.7% and 30.1%) compared with the control group (8.6% and 17.1%). In the multivariate analysis, in‐hospital mortality rates in CKD and HD groups were higher than control group hazard ratio (HR): 4.33 (95% confidence interval CI: 1.53‐12.26) and HR: 3.09 (95% CI: 1.04‐9.17), respectively.
Conclusion
Among older COVID‐19 patients, in‐hospital mortality is significantly higher in those with stage 3‐5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, co‐morbidities, clinical and laboratory data on admission.
By using of peripherally tetrakis‐2,6‐dimethoxyphenoxy substituted Co(II), Fe(III), and Mn(III) phthalocyanines was observed to extend the redox richness of the phthalocyanine ring with the addition ...of reversible metal‐based electron transfer couples to the phthalocyanine ring‐based electron transfer processes in solution. The emergence of highly steady anionic and cationic redox species with clear spectral and colour changes both in solution and in the film during in situ spectroelectrochemical and in situ electrocolorimetric measurements pointed out their applicability as electrochromic materials. Furthermore, the phthalocyanine complexes demonstrated strong interaction with dioxygen and thus, high electrocatalytic enforcement for its reduction.
•The synthesis of peripherally (5-(tert-butyl)−2-((3,4-dicyanophenoxy)methyl)phenyl)-methanolate substituted MPcs.•Analyzing of the electron transfer properties of all complexes.•Studying of their ...high electrocatalytic activity for oxygen reduction.•Investigation of suitability of them for electrochromic and electrocatalytic applications.
This work involves the synthesis and characterization of metallic (Co, Fe, Mn, Ni, Zn) ball-type phthalocyanine precursors by using novel 4,4′-(((4-(tert-butyl)-1,2-phenylene)bis-(methylene))bis(oxy))diphthalonitrile starting compound. The classical oxo-bridge in phthalocyanines was altered with the -OCH2- bridge first time for these ball-type phthalocyanine precursors, and the effects of this change on the chemical, physical and spectral features of phthalocyanine complexes were investigated, in the study. The redox properties of phthalocyanines were researched by electrochemical and in situ spectroelectrochemical measurements on a Pt working electrode in non-aqueous medium. The color changes involved in the redox processes were observed via in situ electrocolorimetric techniques. Electrochemical and UV–Vis spectral measurements exhibited that the compounds had reversible and serial one-electron reduction and oxidation processes. Furthermore, they also had nitrile reduction processes because of opened nitrile groups located at peripheral tails of the phthalocyanine complexes. The plentiful redox conducts of the complexes such as Pc ring based and/or central redox active metal-based reduction and oxidation reactions at low potentials showed that these complexes can be used as functional materials. Because of the apparent spectral and net color changes, the complexes are suitable for utilization in electrochromic devices. Moreover, their rich redox features are a sign of their high electrocatalytic activity for oxygen reduction.
This work involves the synthesis and characterization of metallic (Co, Fe, Mn, Ni, Zn) ball-type phthalocyanine precursors by using novel 4,4′-(((4-(tert-butyl)-1,2-phenylene)bis(methylene))bis-(oxy))diphthalonitrile starting compound. The classical oxo-bridge in phthalocyanines was altered with the OCH2 bridge first time for these ball-type phthalocyanine precursors, and the effects of this change on the chemical, physical and spectral features of phthalocyanine complexes were investigated. The redox properties of phthalocyanines were researched by electrochemical and in situ spectroelectrochemical measurements on a Pt working electrode in non-aqueous medium. The color changes involved in the redox processes were observed via in situ electrocolorimetric techniques and the complexes are suitable for utilization in electrochromic devices. Moreover, their rich redox features are a sign of their high electrocatalytic activity for oxygen reduction. Display omitted
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.
The largest data on the epidemiology of primary glomerular diseases (PGDs) are obtained from the databases of countries or centers. Here, we present the extended results of the Primary Glomerular ...Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group.
Data of patients who underwent renal biopsy and received the diagnosis of PGD were recorded in the database prepared for the study. A total of 4399 patients from 47 centers were evaluated between May 2009 and May 2019. The data obtained at the time of kidney biopsy were analyzed. After the exclusion of patients without light microscopy and immunofluorescence microscopy findings, a total of 3875 patients were included in the study.
The mean age was 41.5 ± 14.9 years. 1690 patients were female (43.6%) and 2185 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGD was IgA nephropathy (25.7%) followed by membranous nephropathy (25.6%) and focal segmental glomerulosclerosis (21.9%). The mean total number of glomeruli per biopsy was 17 ± 10. The mean baseline systolic blood pressure was 130 ± 20 mmHg and diastolic blood pressure was 81 ± 12 mmHg. The median proteinuria, serum creatinine, estimated GFR, and mean albumin values were 3300 (IQR: 1467-6307) mg/day, 1.0 (IQR: 0.7-1.6) mg/dL, 82.9 (IQR: 47.0-113.0) mL/min and 3.2 ± 0.9 g/dL, respectively.
The distribution of PGDs in Turkey has become similar to that in other European countries. IgA nephropathy diagnosed via renal biopsy has become more prevalent compared to membranous nephropathy.
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