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. 2023 Nov 28;17(1):sfad283.
doi: 10.1093/ckj/sfad283. eCollection 2024 Jan.

Risk factors for COVID-19 hospitalization and mortality in patients with chronic kidney disease: a nationwide cohort study

Angelica Artborg  1   2 , Aurora Caldinelli  1   3 , Julia Wijkström  1   2 , Alexandra Nowak  1   2 , Michael Fored  4 , Maria Stendahl  5   6 , Marie Evans  1   2   6 , Helena Rydell  1   2   6
Affiliations

Risk factors for COVID-19 hospitalization and mortality in patients with chronic kidney disease: a nationwide cohort study

Angelica Artborg et al. Clin Kidney J. .

Abstract

Background: Several studies have demonstrated an increased risk of severe coronavirus disease 2019 (COVID-19) in chronic kidney disease (CKD) patients. However, few have investigated the impact of CKD stage and dialysis modality. The primary aim of this study was to investigate the association between CKD stage, dialysis modality and risk of severe COVID-19. Secondly, we aimed to study the impact of comorbidities and drugs on the risk of severe COVID-19 in the CKD population.

Methods: This nationwide observational study was based on data from the Swedish Renal Registry and three other national registries. Patients with non-dialysis CKD stage 3b-5 or dialysis on 1 January 2020 were included and followed until 31 December 2021. The primary outcome was COVID-19 hospitalization; the secondary outcome was COVID-19 mortality. Associations were investigated using logistic regression models, adjusting for confounders.

Results: The study population comprised 7856 non-dialysis CKD patients and 4018 dialysis patients. The adjusted odds ratios (aOR) for COVID-19 hospitalization and mortality were highest in the dialysis group [aOR 2.24, 95% confidence interval (CI) 1.79-2.81; aOR 3.10, Cl 95% 2.03-4.74], followed by CKD 4 (aOR 1.33, 95% CI 1.05-1.68; aOR 1.66, Cl 95% 1.07-2.57), as compared with CKD 3b. No difference in COVID-19 outcomes was observed between patients on hemodialysis and peritoneal dialysis. Overall comorbidity burden was one of the strongest risk factors for severe COVID-19 and the risk was also increased in patients prescribed insulin, proton pump inhibitors, diuretics, antiplatelets or immunosuppressants.

Conclusions: Worsening CKD stage and comorbidity are independent risk factors for severe COVID-19 in the Swedish CKD population.

Keywords: CKD; COVID-19; dialysis; mortality; risk factors.

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Conflict of interest statement

No potential conflicts of interests relevant to this article were declared.

Figures

Figure 1:
Figure 1:
Inclusion and exclusion of patients with CKD stage 3b–5 or dialysis.
Figure 2:
Figure 2:
Unadjusted cumulative incidence with 95% CIs of a first COVID-19 hospitalization or COVID-19 death before hospitalization (A) and COVID-19 mortality (B) in adult patients with CKD stage 3b (blue line), stage 4 (red line), stage 5 (green line) and dialysis (brown line) during January 2020 to December 2021.
See this image and copyright information in PMC

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