Chronic kidney disease predicts poor outcomes of COVID-19 patients

Gök, Mahmut; Çetinkaya, Hakkı; Kandemir, Tugba; Karahan, Erdem; Tuncer, İzzet Burak; Bukrek, Cengiz; Şahin, Gülizar Manga

doi:10.1007/s11255-020-02758-7

Cited by 30 publications

(29 citation statements)

References 35 publications

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“…In the cohort of Gok et al, including 609 consecutive adult patients hospitalized with a diagnosis of COVID-19 in a tertiary-level hospital, the percentage of patients with low eGFR was close to 21%, rather similar to our finding [18]. A quarter of the evaluated patients showed AKI [18].…”

Section: Discussionsupporting

confidence: 89%

“…In line with these findings, Uribarri et al showed an increased risk for in-hospital complications and mortality among patients with renal failure [15]. Similarly, according to Gok et al, both AKI and CKD are independently associated with mortality [18]. On the contrary, Bravi et al, did not find eGFR to be an independent predictor of poor outcomes.…”

Section: Discussionmentioning

confidence: 84%

“…At present, most of the evidence suggests a negative impact of reduced GFR on the course and outcome of COVID-19, with an increased risk of admission to the Intensive Care Unit (ICU) [16] and death [4,5,14,15,[17][18][19] among patients with reduced renal function. However, not all studies confirmed this association [20].…”

Section: Introductionmentioning

confidence: 99%

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Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Mirijello

Piscitelli

Matthaeis

et al. 2021

JCM

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Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 84%

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Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Mirijello

Piscitelli

Matthaeis

et al. 2021

JCM

View full text Add to dashboard Cite

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“…The incidence of in-hospital mortality in this study was 18%. As already described by other authors [15][16][17], the presence of reduced renal function increases mortality rate. In most studies, CKD is defined as the presence of eGFR <60 mL/min, with no further differentiation between the various stages of renal disease.…”

Section: Discussionsupporting

confidence: 58%

Atrial Fibrillation and Clinical Outcomes in a Cohort of Hospitalized Patients with Sars-Cov-2 Infection and Chronic Kidney Disease

Genovesi

Rebora

Occhino

et al. 2021

JCM

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The aim of the study was to investigate the role of chronic kidney disease (CKD) on in-hospital mortality and on incident atrial fibrillation (AF) in patients infected with SARS-CoV-2. The incidence of acute kidney injury (AKI) was also investigated. Multivariable regression models were used to assess the association between renal function groups (estimated Glomerular Filtration Rate, eGFR, >60 mL/min, 30–59 mL/min, <30 mL/min) and in-hospital all-cause mortality and incident AF and AKI. A cohort of 2816 patients admitted in one year for COVID-19 disease in two large hospitals was analyzed. The independent predictors of mortality were severe CKD [HR 1.732 (95%CI 1.264–2.373)], older age [HR 1.054 (95%CI 1.044–1.065)], cerebrovascular disease [HR 1.335 (95%CI (1.016–1.754)], lower platelet count [HR 0.997 (95%CI 0.996–0.999)], higher C-reactive protein [HR 1.047 (95%CI 1.035–1.058)], and higher plasma potassium value 1.374 (95%CI 1.139–1.658)]. When incident AKI was added to the final survival model, it was associated with higher mortality [HR 2.202 (1.728–2.807)]. Incident AF was more frequent in patients with CKD, but in the multivariable model only older age was significantly related with a higher incidence of AF [OR 1.036 (95%CI 1.022–1.050)]. Incident AF was strongly associated with the onset of AKI [HR 2.619 (95%CI 1.711–4.009)]. In this large population of COVID-19 patients, the presence of severe CKD was an independent predictor of in-hospital mortality. In addition, patients who underwent AKI during hospitalization had a doubled risk of death. Incident AF became more frequent as eGFR decreased and it was significantly associated with the onset of AKI.

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“…Later observational data suggest that patients with CKD are at higher risk for severe COVID-19 disease and mortality during admission, ranging from 2.1-fold [95% confidence interval (CI): 1.36-3.26] higher for elevated serum creatinine, to 3.9-fold higher (95%CI: 2.57-6.14) for elevated blood urea nitrogen levels [15]. These observations have been confirmed in several subsequent studies [41][42][43]. In the largest study, including > 17 million primary care records from the United Kingdom (UK) and 10,926 COVID-19-related deaths, patients with estimated glomerular filtration rate (eGFR) 30-60 ml/ min/1.73 m 2 [Hazard Ratio (HR): 1.33, 95%CI: 1.28-1.40] and < 30 ml/min/1.73 m 2 (HR: 2.52, 95%CI: 2.33-2.72) had higher mortality risk compared to those with eGFR > 60 ml/ min/1.73 m 2 , corresponding to mortality rates of 0.4% and 1.11%, respectively [16].…”

Section: Cardiovascular Complications In Ckd Patients With Covid-19mentioning

confidence: 80%

Cardiovascular complications after COVID-19 in chronic kidney disease, dialysis and kidney transplant patients

et al. 2021

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Chronic kidney disease predicts poor outcomes of COVID-19 patients

Cited by 30 publications

References 35 publications

Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Atrial Fibrillation and Clinical Outcomes in a Cohort of Hospitalized Patients with Sars-Cov-2 Infection and Chronic Kidney Disease

Cardiovascular complications after COVID-19 in chronic kidney disease, dialysis and kidney transplant patients

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