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.
Aim:Inflammation plays an important role in the development of diabetic nephropathy (DNP). In our study, we aimed to analyze the relationship between the mean platelet volume (MPV), ...neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), uric acidlymphocyte ratio (UALR), and uric acid level with early diagnosis of DNP and DNP progression.Methods:Our cross-sectional study, which is a type of observational study, included patients diagnosed with type 2 diabetes mellitus and followed in the internal medicine and nephrology clinics of our hospital. Patients were divided into four groups: Group 1: estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2 and albuminuria <30 mcg/day; Group 2: eGFR >60 mL/min/1.73 m2 and albuminuria: 30-300 mcg/day; Group 3: eGFR >60 mL/min/1.73 m2 and albuminuria >300 mcg/day; and Group 4: eGFR <60 mL/ min/1.73 m2 and albuminuria >300 mcg/day. Thirty-six patients were included in group 1, 38 patients in group 2, 35 patients in group 3, and 40 patients in group 4. Mean platelet volume, NLR, PLR, UALR, and uric acid levels were compared among the groups.Results:A total of 149 patients were included in the study; 57.7% were female, and the mean age was 55.2±9.2 years. Significant differences were found among the groups in terms of MPV, PLR, NLR, and UALR (p<0.001, p=0.023, p≤0.001, p<0.001, respectively). There was a negative correlation between eGFR and MPV (r=-0.218, p=0.008). While there was no relationship between eGFR and platelet values, a relationship was obtained when platelets were compared with lymphocytes (r=-0.263, p=0.002). There was a weak relationship between eGFR and neutrophil levels (r=-0.188, p=0.026), but a stronger relationship was found when neutrophil and lymphocyte values were rationed (r=-0.414, p<0.001).Conclusion:Mean platelet volume, PLR, NLR, UALR, and uric acid levels, especially MPV, can be used in the development and progression of DNP.
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.
Purpose
Sodium-glucose co-transporter-2 inhibitor (SGLT-2i) administration is associated with some concerns in regard to the increased risk of genital and urinary tract infections (UTI) in kidney ...transplant recipients (KTR). In this study, we present the results of SGLT-2i use in KTR, including the early post-transplant period.
Methods
Participants were divided into two groups: SGLT-2i-free diabetic KTR (Group 1, n = 21) and diabetic KTR using SGLT-2i (Group 2, n = 36). Group 2 was further divided into two subgroups according to the posttransplant prescription day of SGLT-2i; < 3 months (Group 2a) and ≥ 3 months (Group 2b). Groups were compared for development of genital and urinary tract infections, glycated hemoglobin a1c (HgbA1c), estimated glomerular filtration rate (eGFR), proteinuria, weight change, and acute rejection rate during 12-month follow-up.
Results
Urinary tract infections prevalence was 21.1% and UTI-related hospitalization rate was 10.5% in our cohort. Prevalence of UTI and UTI-related hospitalization, eGFR, HgbA1c levels, and weight gain were similar between the SGLT-2i group and SGLT-2i-free group, at the 12-month follow-up. UTI prevalence was similar between groups 2a and 2b (p = 0.871). No case of genital infection was recorded. Significant proteinuria reduction was observed in Group 2 (p = 0.008). Acute rejection rate was higher in the SGLT-2i-free group (p = 0.040) and had an impact on 12-month follow-up eGFR (p = 0.003).
Conclusion
SGLT-2i in KTR is not associated with an increased risk of genital infection and UTI in diabetic KTR, even in the early posttransplant period. The use of SGLT-2i reduces proteinuria in KTR and has no adverse effects on allograft function at the 12-month follow-up
.
Aim: The aim of this study was to determine the relationship between left ventricular hypertrophy (LVH) and inflammatory markers in patients with type 2 Diabetes Mellitus (T2DM) with diabetic ...nephropathy at different stages.
Methods: Our study was a cross-sectional study involving patients with various stage of T2DM. Patients with LVH were identified by 2D echocardiography. Plasma human tumor necrosis factor alpha (TNF-α), interleukin (IL)-1, IL-6, vaspin, vispatin and midkine were measured.
Results: A total of 59 T2DM patients (56% women) with a mean age of 56.1±8.8 years were included in the study. The mean left ventricular mass index was 129±30. LVH was detected in 62.7% of the patients. Patients with an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 had a higher incidence of LVH than patients with an eGFR ≥60 mL/min/1.73 m2 (p=0.03). The TNF-α levels in patients with LVH with low eGFR was found to be statistically significantly higher than in patients without LVH (p=0.047). The level of vaspin was statistically significantly higher in patients with LVH (p=0.01).
Conclusion: LVH was found to be more frequent in patients with low eGFR, and from inflammatory markers, it was found to be associated only with TNF-α and vaspin.
Aim:There is no enough data on pulmonary involvement in autosomal dominant polycystic kidney disease (ADPKD). The aim of this study is to examine pulmonary function test in patients with ADPKD with ...varying stages of renal function and to compare them with those in healthy controls.Methods:Forty-six patients with ADPKD and 43 healthy control subjects were included in the study. Pulmonary function test was performed for each patient after routine physical examination and biochemical analysis.Results:Age, gender, weight, height and smoking rate were similar in both groups. Seven patients (15.2%) had restrictive pattern and one (2.1%) had obstructive pattern in ADPKD group while one patient (2.3%) had obstructive pattern and two (4.6%) had restrictive pattern in the control group. The frequency of restrictive pattern was not significantly higher (p=0.15), but forced vital capacity volume was significantly lower in the patient group (p=0.04).Conclusion:Restrictive spirometric pattern was more prevalent in the patient group, but there was no statistically significant difference. It is thought that the difference may be statistically significant when the study is performed with kidney volume analysis and larger patient population.
Aim:Focal segmental glomerulosclerosis (FSGS) is one of the common glomerulonephritis in Turkey and the world. The aim of our study was to determine demographic and clinical features and biopsy ...results of patients who were followed up with primary FSGS in our center.Methods:Ninety-nine adult patients with FSGS diagnosed via renal biopsy, who were followed up in our outpatient clinic, were included in our single-center, retrospective, cross-sectional study. Patients with secondary FSGS were excluded. Demographic and clinical features and biopsy results were examined retrospectively.Results:Fifty-nine patients (59.6%) were women. Nephrotic syndrome was the most common biopsy indication (68.7%) and the mean estimated glomerular filtration rate at presentation was 78.9±35.8 mL/min/1.73 m2. The mean serum albumin level was 3.2±0.9 g/dL and urine protein level was 3485 mg/day (interquartile range: 1739-7275). Interstitial fibrosis was detected in 63.4% and tubular atrophy in 74.7% of patients.Conclusion:The complaints and clinical data of our patients with FSGS were similar with the country and world data. Approximately 40% of the patients presented with decreased renal functions at the time of biopsy. Biopsy should be considered earlier in patients suspected of FSGS, as tubular atrophy and interstitial fibrosis rates were high in biopsies.
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