Coronavirus Disease 2019 and Chronic Kidney Disease - A Clinical Observational Study.

ABSTRACT

People with comorbidities are more prone to severe coronavirus disease 19 (COVID-19) infection. Chronic kidney disease (CKD) patients are commonly associated with other comorbidities such as diabetes mellitus, hypertension, or cardiovascular disease. However, there are limited data about the clinical features and laboratory parameters of COVID-19 in CKD patients. The primary objective was to study the admission clinical and laboratory parameters of COVID-19 in CKD patients. The secondary objective was to correlate the clinical and laboratory parameters at admission with mortality in CKD patients. Data were collected retrospectively from patients' medical records between July 2020 and October 2020. All CKD patients with either COVID-19 antigen or reverse transcription-polymerase chain reaction-confirmed infection were included in the study. Demographic, clinical, and laboratory data were recorded. Data of deceased and recovered patients were compared and analyzed. The mortality rate due to COVID-19 in CKD patients was 34.44%. CKD patients presented with atypical symptoms such as dyspnea (78.88%) and fatigue (73.33%) being more common than fever and sore throat. Elderly patients with comorbidities were at a higher risk of mortality (P = 0.003). CKD patients requiring renal replacement therapy (RRT) were at a higher risk of mortality than those who did not require RRT (P = 0.02). High values of high-sensitive C-reactive protein, lactate dehydrogenase, neutrophil-lymphocyte ratio, and red cell distribution width at admission were associated with a higher risk of mortality. Liver dysfunction and hypoxia at admission were also associated with a higher risk of mortality. Logistic regression analysis showed that improvements in serum albumin, serum sodium, and serum lactate were the best predictors of recovery among cases of COVID-19. In the absence of a definitive therapy or vaccine, CKD patients should be advised to follow strict social isolation practices as per the recommendations for the high-risk group of patients. These practices should be extended to dialysis units as well, which are a major hub for outbreak of infections. A meticulous triage of patients should be carried out after acquiring proper medical history because this will help to identify patients who are at an increased risk of poor outcome of the infection. Furthermore, they should be given more aggressive treatment and access to intensive care unit upon diagnosis of infection.