COVID-19 in Patients with CKD in New York City

Abstract

Background: Coronavirus disease 2019 (COVID-19) has affected millions of people, and several chronic medical conditions appear to increase the risk of severe COVID-19. However, our understanding of COVID-19 outcomes in patients with chronic kidney disease (CKD) remains limited. Methods: This was a retrospective cohort study of patients with and without CKD consecutively admitted with COVID-19 to three affiliated hospitals in New York City. Pre-COVID-19 CKD diagnoses were identified by billing codes and verified by manual chart review. In-hospital mortality was compared between patients with and without underlying CKD. Logistic regression was used to adjust this analysis for confounders and to identify patient characteristics associated with mortality. Results: We identified 280 patients with CKD, and 4098 patients without CKD hospitalized with COVID-19. The median age of CKD group was 75 (65-84) years, and age of non-CKD group 62 (48-75) years. Baseline (pre-COVID-19) serum creatinine in patients with CKD was 1.5 (1.2-2.2) mg/dL. In-hospital mortality was 30% in patients with CKD vs. 19.9% in patients without CKD (p<0.001). The risk of in-hospital death in patients with CKD remained significantly higher after adjustment for comorbidities (hypertension, diabetes mellitus, asthma, and chronic obstructive pulmonary disease), adjusted OR 1.4 [1.1-1.9]. When stratified by age, elderly patients with CKD (above age 70) had higher mortality than their age-matched control patients without CKD. In patients with CKD, factors associated with in-hospital mortality were age (adjusted OR 1.09 [1.06-1.12]), baseline and admission serum phosphorus (adjusted ORs 1.5 [1.03-2.1] and 1.4 [1.1-1.7]), serum creatinine on admission >0.3 mg/dL above the baseline (adjusted OR 2.6 [1.2-5.4]), and diagnosis of acute on chronic kidney injury during hospitalization (adjusted OR 4.6 [2.3-8.9]). Conclusions: CKD is an independent risk factor for COVID-19 associated in-hospital mortality in elderly patients. Acute on chronic kidney injury increases odds of in-hospital mortality in CKD patients hospitalized with COVID-19.

Association of Kidney Function With 30-Day Mortality Following SARS-CoV-2 Infection in Nursing Home Residents: A Retrospective Cohort Study

“…Prior studies have shown higher SARS-CoV-2 mortality among hospitalized older adults with CKD, and among nursing home residents with kidney failure or renal insufficiency documented in the MDS. 2,6,9 Our study corroborates and expands upon these findings by using creatinine-based determination of CKD stage, allowing a more granular assessment of how CKD at different stages is associated with mortality.…”

“…[1][2][3][4] Independently, chronic kidney disease (CKD) is a significant predictor of mortality in nursing home residents with SARS-CoV-2, 2,3 as well as in the general population. [4][5][6][7][8][9] However, the relationship between CKD stage and SARS-CoV-2 mortality has not been explored among nursing home residents. We described the association between CKD stage and all-cause 30-day mortality following SARS-CoV-2 diagnosis among nursing home residents.…”

Risk factors for mortality in hemodialysis patients with COVID-19: a systematic review and meta-analysis

“…CKD is an independent risk factor for COVID-19-associated in-hospital mortality in elderly patients, and acute-on-chronic kidney injury increases the odds of in-hospital mortality in patients with CKD hospitalized with COVID-19 [ 44 ]. A study showed that compared with patients without preexisting CKD, dialysis patients had a higher risk for 28-d in-hospital death, whereas patients with non-dialysis-dependent CKD had an intermediate risk [ 45 ].…”

Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study

“…Many studies analyzed the relation between pre-existing renal disease and worse outcome in the form of higher mortality [19][20][21], need for hospitalization, and intensive care admission in patients with SARS-CoV2 infection [22]. A propensity-score match study conducted in a multicenter study of electronic medical records in a cohort of 152,463 patients found that any grade and in particular moderate chronic kidney disease (CKD) was an independent risk factor for more severe COVID-19 disease presentation and mortality, after accounting for other coexistent comorbidities [23].…”