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    Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology
    (2021) Arıkan, Hakkı; Öztürk, Savaş; Tokgöz, Bülent; Dursun, Belda; Seyahi, Nurhan; Trabulus, Sinan; İslam, Mahmud; Ayar, Yavuz; Görgülü, Numan; Karadağ, Serhat; Eren,Zehra; Tuğlular, Serhan
    Background Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. Conclusions Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.
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    Post-Earthquake Realities: A Study on the Challenges of Relocated Hemodialysis Patients Following the Kahramanmaras Earthquake
    (Aves, 2025) Tugcu, Murat; Keles, Mustafa; Duranay, Murat; Huddam, Bulent; Yazici, Raziye; Ayar, Yavuz; Guzel, Fatma Betul
    On February 2023 T & uuml;rkiye experienced siniicant rtas ri.Background: In February 2023, T & uuml;rkiye experienced 2 significant earthquakes, measuring 7 .4 and 7.3 on the Richter scale and impacting 11 provinces. This study was performed to investigate the experiences of patients undergoing hemodialysis ftreatment in earthquake-affected areas who were relocated to alternative centers, with a focus on assessing the medical tchallenges that emerged thereafter. Methods: This study included 181 hemodialysis patients (71 females, 110 males) from 11 earthquake-affected provinces fwho were transferred to different dialysis centers because of infrastructure and superstructure damage at their original treatment facilities. Results: The predominant reason for relocation was damage to personal residences, reported by 77.4% of patients. Notably, 59.4% resumed hemodialysis with a delay of at least 1 day. Emergency complications were observed in 24.6% of patients, with hypervolemia (11.7%) being the most common. At the time of reporting, 23.1% of patients continued treatment at the relocated centers, while 78.8% expressed intent to return to their original facilities. Importantly, only 1 patient was reported to have died during the study period, highlighting the overall resilience of this population. Conclusion: Hemodialysis patients are particularly vulnerable to the impacts of earthquake-related disruptions. Dialysis centers in high-risk regions must adhere to construction standards that ensure operational resilience. Additionally, prioritizing the transfer and medical coordination of hemodialysis patients during disasters is essential to maintaining continuity of care and minimizing health risks.