COVID‐19 death and kidney disease in a multiracial Asian country

Abstract

Introduction COVID‐19 infection and kidney disease (KD) carry a considerable risk of mortality. Understanding predictors of death and KD may help improve management and patient outcome. Methods This is a prospective multicentre observational study conducted in a multiracial Asian country to identify predictors of death and acute kidney injury (AKI) in hospitalized COVID‐19 patients from January to June 2020. Results A total of 6078 patients were included in this study. Mean age was 37.3 (±16.8) years, 71% were male, 59.4% Malay, 6.7% Chinese, 2.3% Indian and 31.7% other ethnicities. AKI was seen in 3.5% of patients while 1.6% had pre‐existing chronic kidney disease (CKD). Overall case fatality rate (CFR) was 1.3%. Patients with KD (AKI and CKD) had CFR of 20%. Many factors were associated with increased risk of death and AKI. However, significant predictors of death after adjustment for covariates were age (>70 years), Chinese ethnicity, diabetes mellitus (DM) and KD. Adjusted predictors of AKI were age (>51 years), DM and severity at presentation. Chinese were 2.58 times more likely to die ( p = .036) compared to Malay. Centre capacity to manage, ventilate and dialyze patients significantly influenced death. Among those with AKI, the most common symptoms were fever, cough, and dyspnea. They had lower absolute lymphocyte count, were more likely to be admitted to ICU, required more ventilation and longer hospitalization. Conclusion Patient and centre factors influence death and AKI among COVID‐19 patients. This study also demonstrates death disparities across different racial groups and centre capacities in this multiracial Asian country.

A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country

“…These findings concur with other reports indicating age as an independent predictor for AKI [14,36,37]. Furthermore, age has also been reported as a risk factor for death in COVID-19 patients [19,38], suggesting that elderly population is at a higher risk of morbidity and mortality, warranting special attention upon admission. In addition, similar to our study cohort, a retrospective study in London demonstrated a three-fold risk of AKI for patients who developed COVID-19 AKI with pre-existing CKD [16].…”

Clinical outcomes and risk factors for SARS-CoV-2 breakthrough cases following vaccination with BNT162b2, CoronaVac, or ChAdOx1-S: A retrospective cohort study in Malaysia

“…In a multi-centre Malaysian study, Chinese patients demonstrated a statistically significant higher mortality risk compared to Malays (aOR: 2.58; 95 % CI, 1.06–6.26). Conversely, Indians showed a reduced risk, despite being older with more comorbidities; however, this observation was not statistically significant (aOR: 0.25; 95 % CI: 0.03–2.10) [ 35 ]. Contrarily, a meta-analysis from the United Kingdom and Canada found that south Asians (SAs) had a 67 % higher risk of ICU admission than the general population, while Chinese individuals had a 28 % higher risk.…”

How to use COVID-19 antiviral drugs in patients with chronic kidney disease

“…From the published evidence, it is well proven that in CKD patients with COVID-19 the rates of hospitalization and death are higher ( Mirijello et al, 2021 ; Goh et al, 2022 ). These patients are more prone to adverse drug effects due to drug-drug reactions or altered pharmacokinetics and pharmacodynamics because of kidney dysfunction.…”