Mortality and readmission rates among hospitalized COVID-19 patients with varying stages of chronic kidney disease: a multicenter retrospective cohort

Abstract

Chronic kidney disease (CKD) has been recognized as a highly prevalent risk factor for both the severity of coronavirus disease 2019 (COVID-19) and COVID-19 associated adverse outcomes. In this multicenter observational cohort study, we aim to determine mortality and readmission rates of patients hospitalized for COVID-19 across varying CKD stages. We performed a multicenter cohort study among COVID-19 patients included in the Dutch COVIDPredict cohort. The cohort consists of hospitalized patients from March 2020 until July 2021 with PCR-confirmed SARS-CoV-2 infection or a highly suspected CT scan-based infection with a CORADS score ≥ 4. A total of 4151 hospitalized COVID-19 patients were included of who 389 had a history of CKD before admission. After adjusting for all confounding covariables, in patients with CKD stage 3a, stage 3b, stage 4 and patients with KTX (kidney transplantation), odds ratios of death and readmission compared to patients without CKD ranged from 1.96 to 8.94. We demonstrate an evident increased 12-week mortality and readmission rate in patients with chronic kidney disease. Besides justified concerns for kidney transplant patients, clinicians should also be aware of more severe COVID-19 outcomes and increased vulnerability in CKD patients.

Figure 1

(a–c) Unadjusted; age, sex and ethnicity adjusted; and fully adjusted 12-week mortality and readmission odds ratios in patients hospitalized for COVID-19 among CKD groups compared to “no-CKD” with corresponding P values. CKD stage 2 = eGFR 60–79 ml/min/1.73 m², CKD stage 3a = eGFR 45–59 ml/min/1.73 m², CKD stage 3b = eGFR 30–44 ml/min/1.73 m², CKD stage 4 = eGFR 15–29 ml/min/1.73 m², CKD stage 5 = eGFR < 15 ml/min/1.73 m², CKD = chronic kidney disease. P is considered significant at P ≤ 0.05.