Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite its international aggressive extension, with a significant morbidity and mortality, the impact of renal function on its prognosis is uncertain.

Methods: Analysis from the international HOPE-Registry (NCT04334291). The objective was to evaluate the association between kidney failure severity on admission with the mortality of patients with SARS-CoV-2 infection. Patients were categorized in 3 groups according to the estimated glomerular filtration rate on admission (eGFR > 60 mL/min/1.73 m², eGFR 30-60 mL/min/1.73 m² and eGFR < 30 mL/min/1.73 m²).

Results: 758 patients were included: mean age was 66 ± 18 years, and 58.6% of patient were male. Only 8.5% of patients had a history of chronic kidney disease (CKD); however, 30% of patients had kidney dysfunction upon admission (eGFR < 60 mL/min/1.73 m²). These patients received less frequently pharmacological treatment with hydroxychloroquine or antivirals and had a greater number of complications such as sepsis (11.9% vs 26.4% vs 40.8%, p < 0.001) and respiratory failure (35.4% vs 72.2% vs 62.0%, p < 0.001) as well as a higher in-hospital mortality rate (eGFR > 60 vs eGFR 30-60 vs and eGFR < 30, 18.4% vs 56.5% vs 65.5%, p < 0.001). In multivariate analysis: age, hypertension, renal function, 0² saturation < 92% and lactate dehydrogenase elevation on admission independently predicted all-cause mortality.

Conclusions: Renal failure on admission in patients with SARS-CoV-2 infection is frequent and is associated with a greater number of complications and in-hospital mortality. Our data comes from a multicenter registry and therefore does not allow to have a precise mortality risk assessment. More studies are needed to confirm these findings.

Keywords: Acute kidney injury; COVID-19; Chronic kidney failure; Mortality; Prognosis; Registry.

Fig. 1

Kaplan–Meier survival landmark analysis according to the glomerular filtration rate

Fig. 2

Association between creatinine clearance and predicted mortality. The predicted probability of all-cause death (red line) is shown, together with 95% confidence interval, after adjustment for age, hypertension, diabetes, dislipemia, smoking habit, any heart disease, any lung disease, any cerebrovascular disease, any immunosuppression condition, RAAS inhibitors treatment, aspirin treatment, anticoagulation treatment, statin treatment, saturation O2 < 92% on admission, d-dimer elevation, PCR elevation, and lactate dehydrogenase elevation at admission. The x-axis shows the values of creatinine clearance as continuous variable. Histograms show the population distribution according to creatinine clearance levels (color figure online)