Outcomes in CKD Patients With COVID-19

ABSTRACT

Background: Chronic kidney disease (CKD) and End-stage renal disease patients are at increased risk of severe disease and worse outcomes in coronavirus disease 2019 (COVID-19). In this study, we compared outcomes, including rates of hospital mortality, major adverse cardiovascular events (MACE) and respiratory failure requiring mechanical ventilation in unvaccinated COVID-19 patients with established CKD/ESRD to COVID-19 patients with baseline normal kidney function. Method(s) Using an observational database, we analyzed 3183 unvaccinated hospitalized COVID-19 PCR-positive patients at Methodist Health System (Dallas, TX) from March 2020 to December 2020. The primary endpoint was all-cause in-hospital mortality. Severe disease was identified as any patient with a major adverse cardiovascular event (MACE) or respiratory failure requiring mechanical ventilation. A MACE was defined as congestive heart failure (CHF) exacerbation, myocardial infarction, stroke, pulmonary embolism, deep venous thrombosis, or shock. Chi-square (X2), Fischer's exact test, and odds ratio tests were used to analyze observed variables. Result(s) Of the 3183 COVID-19 patients, 476 (15%) had pre-existing kidney disease (either CKD or ESRD), 170 (5.4%) were dialysis-dependent and 279 (8.79%) were CKD KDIGO stages 1-5. Compared to the non-CKD group, the CKD/ESRD group had an increased risk of all-cause in-hospital mortality (OR = 1.41, 95% CI = 1.04-1.83, p < 0.04). CKD/ESRD patients also had increased risk of MACE (OR = 1.24, 95% CI = 1.03-1.48, p < 0.02), specifically, higher risk of CHF exacerbation (OR = 3.28, 95% CI = 2.16-4.97, p < 0.001) and shock (OR = 1.36, 95% CI 1.01-1.84, p < 0.04). The risk of respiratory failure requiring mechanical ventilation was comparable between the CKD/ESRD and non-CKD cohorts (OR = 1.06, 95% CI 0.78-1.44, p = 0.70). Conclusion(s) The COVID-19 pandemic had worldwide devastating outcomes for vulnerable groups such as CKD patients. In our study, we demonstrated that CKD and ESRD is associated with a higher incidence of mortality and MACE in COVID-19. By understanding the clinical course of these patients, clinicians may better anticipate and attempt to improve outcomes during inpatient visits.