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COVID-19 in Patients with CKD in New York City
Oleh Akchurin1,2, Kelly Meza1, Sharmi Biswas1
1Division of Pediatric Nephrology, Department of Pediatrics, Weill Cornell Medicine, New York, New York.
Insights
Patients with chronic kidney disease (CKD) face higher in-hospital mortality from COVID-19, especially older adults. Acute-on-chronic kidney injury further elevates this risk, highlighting CKD as an independent risk factor.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 has a significant global impact, with certain chronic conditions increasing severe illness risk.
- Limited understanding exists regarding COVID-19 outcomes specifically in patients with chronic kidney disease (CKD).
Purpose of the Study:
- To investigate the association between CKD and in-hospital mortality among COVID-19 patients.
- To identify risk factors for mortality in CKD patients hospitalized with COVID-19.
Main Methods:
- Retrospective cohort study of COVID-19 patients with and without CKD admitted to New York City hospitals.
- CKD diagnosis confirmed via billing codes and manual chart review.
- Logistic regression analysis adjusted for comorbidities to compare in-hospital mortality.
Main Results:
- 30% in-hospital mortality in CKD patients vs. 20% in non-CKD patients (P<0.001).
- CKD remained an independent risk factor for mortality (adjusted OR 1.4, P=0.01), particularly in elderly patients (>70 years).
- Factors associated with mortality in CKD patients included age, serum phosphorus, elevated creatinine, and acute-on-chronic kidney injury.
Conclusions:
- CKD is an independent predictor of in-hospital mortality in COVID-19 patients, especially the elderly.
- Acute-on-chronic kidney injury significantly increases mortality odds in hospitalized CKD patients with COVID-19.
Background:
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 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 the CKD group was 75 (65-84) years, and age of the 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 versus 20% in patients without CKD (P<0.001). The risk of in-hospital death in patients with CKD remained higher than in patients without CKD after adjustment for comorbidities (hypertension, diabetes mellitus, asthma, and chronic obstructive pulmonary disease), adjusted OR 1.4 (95% CI,1.1 to 1.9), P=0.01. When stratified by age, elderly patients with CKD (age >70 years) 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 [95% CI, 1.06 to 1.12]), P<0.001, baseline and admission serum phosphorus (adjusted OR, 1.5 [95% CI, 1.03 to 2.1], P=0.03 and 1.4 [95% CI, 1.1 to 1.7], P=0.001), serum creatinine on admission >0.3 mg/dl above the baseline (adjusted OR 2.6 [95% CI, 1.2 to 5.4]P=0.01), and diagnosis of acute on chronic kidney injury during hospitalization (adjusted OR 4.6 [95% CI, 2.3 to 8.9], P<0.001).
Conclusions:
CKD is an independent risk factor for COVID-19-associated in-hospital mortality in elderly patients. Acute-on-chronic kidney injury increases the odds of in-hospital mortality in patients with CKD hospitalized with COVID-19.
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