The OpenSAFELY project analysed factors associated with COVID-19 deaths in 17 million patients. The picture that arose differs significantly from initial reports. For example, hypertension is not an independent risk factor for COVID-19 death, but renal disease very much is. Dialysis (aHR 3,69), organ transplantation (aHR 3,53) and CKD (aHR 2,52 for patients with eGFR < 30 mL/min/1.73 m2) represent three of the four co-morbidities associated with the highest mortality risk from COVID-19. The risk associated with CKD Stages 4 and 5 was higher than the risk associated with diabetes mellitus (aHR range 1,31–1,95, depending upon glycemic control) or chronic heart disease (aHR 1,17). These findings define essential action points, among which is advocating the inclusion of CKD patients in clinical trials when testing the efficacy of drugs and vaccines to prevent severe COVID-19 (ERA 2020).
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ERA-EDTA Council, ERACODA Working Group. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrology Dialysis Transplantation December 19 2020. Full-text: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaa314/6041849
Ultimately, the current situation might lead to substantial changes in how research and medicine are practiced in the future. The SARS-CoV-2 pandemic has created major dilemmas in almost all areas of health care. Scheduled operations, numerous types of treatment and appointments have been cancelled world-wide or postponed to priorities hospital beds and care for those who are seriously ill with COVID-19. Throughout the world, health systems had to consider rapidly changing responses while relying on inadequate information. In some settings such as HIV or TB infection, oncology or solid organ transplantation, these collateral damages may have been even greater than the damage caused by COVID-19 itself. Treatment interruptions, disrupted drug supply chains and consequent shortages will likely exacerbate this issue. During the next months, we will learn more and provide more information on the consequences of this crisis on various diseases.
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