COVID-19 in CKD patients: lessons from 553 CKD patients with biopsy-proven kidney disease

ABSTRACT

Background: COVID-19 is a novel coronavirus currently at the centre of a global pandemic, and patients with cardiovascular risk factors such as hypertension and diabetes are at risk of a serious complication such as hospitalization and death. Chronic kidney disease (CKD) increased cardiovascular risk and >90% of CKD patients presented hypertension. The prognosis and lethality of COVID-19 in patients with biopsy-proven kidney disease has not been previously studied. Methods: Data included patients who underwent a kidney biopsy at the Vall d'Hebron Hospital between January 2013 and February 2020 with diagnostic confirmation and those with high clinical suspicion of SARS-CoV-2 infection during the period from March to May 2020. Results: Of 553 patients, 39(7%) were diagnosed with SARS-CoV2 infection. The mean age was 63.4±15 years. 48.7% were male, 31 hypertension, 19 diabetic, 12 obese and 18 patients had lung disease. The renal histological diagnosis of glomerulonephritis with extracapillary proliferation in 10.3%, allergic interstitial nephritis in 10.3 %, secondary GSFS in 8.5% and diabetic nephropathy in 10.3%. 4 patients were on hemodialysis and 6 had a kidney transplant. Creatinine before infection was 1.52mg/ dL±0,66. 17 patients were under immunosuppressive treatment (14 with prednisone, 8 mycophenolate, 6 tacrolimus, 1 rituximab). 26 patients had confirmation of SARS-CoV2 infection with RT PCR obtained from nasopharyngeal swab. 22 patients required hospital admission [average hospital stay was 16 days±11], of which 4 in the ICU and 6 (15%) died. 15 patients received lopinavir/ritornavir;23 patients, azithromycin;20 patients, hydroxychloroquine;6 patients, tocilizumab;9 patients, intravenous corticosteroids. 11 patients presented impaired renal function, of which 3 were transplanted and 8 with CKD. CKD patients under RAS blockade had less mortality than patients without RAS blockade treatment (29% vs 0%, p=0.014). Conclusions: COVID-19 was diagnosed in 7% of our CKD patients with kidney biopsy. The mortality was 15%, lower than the reported in hemodialysis patients. RAS blockade is not exerting a deleterious effect in our CKD patients with COVID-19 infection, suggesting that they should not be withdrawn.