Presentation and outcomes of chronic kidney disease patients with COVID-19

Abstract

Introduction: COVID-19 is currently a global health issue and an important cause of mortality. Chronic kidney disease (CKD) is one of the risk factors for infection, morbidity and mortality by SARS-CoV-2. In our study, we aimed to evaluate the clinical presentation and outcomes of CKD patients with COVID-19, as well as identify predictors of mortality. Methods: This was a retrospective study of CKD patients admitted in a tertiary-care Portuguese hospital between March and August of 2020. Variables were submitted to univariate and multivariate analysis to determine factors predictive of in-hospital mortality. Results: 130 CKD patients were analyzed (median age 73.9 years, male 60.0%). Hypertension (81.5%), cardiovascular disease (36.2%), and diabetes (54.6%) were frequent conditions. Cough, dyspnea, fever and respiratory failure were also common. Almost 60% had anemia, 50% hypoalbuminemia, 13.8% hyperlactacidemia and 17% acidemia. Mean serum ferritin was 1531 µg/L, mean CRP 8.3 mg/dL and mean LDH 336.9 U/L. Most patients were treated with lopinavir/ritonavir, hydroxychloroquine or corticosteroids and only 2 with remdesivir. Eighty percent had acute kidney injury and 16.2% required intensive care unit admission. The 34 patients who died were older and more likely to have heart failure. They had higher neutrophils/lymphocytes ratio, ferritin, lactate, and LDH levels. Multivariate analysis identified an association between older age [OR 1.1 (CI 1.01-1.24), p=0.027], higher ferritin [OR 1.0 (CI 1.00-1.00), p=0.009] and higher LDH levels [OR 1.0 (CI 1.00-1.01), p=0.014] and mortality. Conclusion: In our cohort of CKD patients with COVID-19, older age, higher ferritin, and higher LDH levels were independent risk factors for mortality.

Microangiopatia trombótica por COVID-19 superposta a doença renal crônica não dialítica: relato de caso

“…A doença grave é mais comum em idosos e naqueles com comorbidades como diabetes mellitus (DM), hipertensão arterial sistêmica (HAS), doença pulmonar obstrutiva crônica (DPOC), doença arterial coronariana e doença renal crônica (DRC). (Branco et al, 2022).…”

Covid-19 e os rins acometidos com lesão aguda ou crônica: um aprendizado crescente

“…Dois estudos de grupos portugueses são apresentados nesse fascículo do JBN 7,8 . Um deles 7 investigou retrospectivamente os impactos transitórios e permanentes da LRA na mortalidade intra-hospitalar de 544 pacientes com Covid-19, dos quais 330 desenvolveram LRA, segundo critérios do KDIGO, sendo 166 de forma persistente e 164 transitoriamente.…”

“…O outro estudo analisou retrospectivamente 130 pacientes com doença renal crônica (DRC) 8 , dos quais 60% são homens, com idade média de 73,9 anos. Destes, 81,5% são hipertensos; 54,6%, diabéticos; e 36,2% têm doença cardiovascular prévia.…”

COVID-19 and acute or chronic kidney disease: a crescent learning

“…Two Portuguese studies are presented in this JBN issue 7 , 8 . One study 7 retrospectively investigated transitory and permanent impacts of AKI in intra-hospital mortality among 544 patients with COVID-19, 330 of which developed AKI based on KDIGO criteria, 166 having the persistent form and 164, the transitory form.…”

“…The other study retrospectively analyzed 130 patients with CKD 8 , 60% of which were men, with average age of 73.9 years, 81.5% were hypertensive, 54.6% diabetic, and 36.2% had previous cardiovascular disease. Eighty percent of participants developed AKI and 16.2% needed ICU treatment on admission.…”