Outcomes of COVID-19 Among Hospitalized Patients With Non-dialysis CKD

Abstract

Background: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Corona Virus 2 has generated significant impact on global health worldwide. COVID-19 can cause pneumonia and organ injury. Chronic kidney disease (CKD) has been associated with increased mortality in previous epidemics, but there is a paucity of data regarding actual risks for non-dialysis CKD patients with COVID-19. Methods: Multicenter, observational cohort study including 136 non-dialysis CKD patients and 136 age- and sex-matched controls that required hospitalization due to COVID-19. Patients with end-stage renal disease, a kidney transplant or without registered baseline glomerular filtration rate prior to COVID-19 infection were excluded. CKD and acute kidney injury (AKI) were defined according to KDIGO criteria. Results: CKD patients had higher white blood cell count and D-dimer and lower lymphocyte percentage. No differences were found regarding symptoms on admission. CKD was associated with higher rate of AKI (61 vs. 24.3%) and mortality (40.4 vs. 24.3%). Patients with AKI had the highest hazard for death (AKI/non-CKD HR:7.04, 95% CI:2.87-17.29; AKI/CKD HR:5.25, 95% CI: 2.29-12.02), followed by CKD subjects without AKI (HR:3.39, 95% CI:1.36-8.46). CKD status did not condition ICU admission or length of in-hospital stay. Conclusions: CKD patients that require hospitalization due to COVID-19 are exposed to higher risk of death and AKI.

Keywords: COVID−19; acute kidney damage; chornic kidney disease; pneumonia; renal failure.

Figure 1

Twenty eight-day survival according to CKD stage and AKI severity. AKI, acute kidney injury; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.

Figure 2

Cumulative Kaplan–Meier survival estimates of the time to patient death. (A) Comparison of CKD vs. non-CKD patients. CKD, chronic kidney disease; NCKD, non-chronic kidney disease. (B) Comparison of stages of CKD severity. *mL/min/1.73m². St, stage. (C) Comparison of CKD and non-CKD patients with and without acute kidney injury. A, acute kidney injury, C, chronic kidney disease, NA, no acute kidney injury. NC, non-chronic kidney disease.

Figure 3

Adjusted proportional hazards model for death. AKI, acute kidney injury; CKD, chronic kidney disease. *p < 0.05, **p < 0.001.

Figure 4

Estimation of cumulative excess risk of based on Aalen's additive model. Aalen's additive model supplements a proportional hazards regression model analysis that describes the nature of time-varying effects of covariates through plots of the estimated cumulative regression coefficients, with confidence bands. AKI, acute kidney injury; CKD, chronic kidney disease.