Clinical Characteristics and Early Outcomes of Hospitalized COVID-19 Patients with End-Stage Kidney Disease in Saudi Arabia
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Published on: April 4, 2025
Ali Hakami1, Mohammed Badedi2, Mohammed Elsiddig1
1Kidney Center, King Fahad Central Hospital, Jazan Health Affairs, Jazan, Saudi Arabia.
Insights
Patients with end-stage kidney disease (ESKD) hospitalized with COVID-19 face a high mortality risk, particularly older individuals and those with diabetes or cardiovascular disease. Inflammatory markers also indicate increased severity and death risk.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Limited data exists on COVID-19 outcomes in Arab countries, especially for patients with end-stage kidney disease (ESKD).
- Prognosis for novel coronavirus disease 2019 (COVID-19) is potentially poor in ESKD patients.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of COVID-19 patients with ESKD in Saudi Arabia.
- To identify risk factors associated with mortality in this vulnerable population.
Main Methods:
- Retrospective cohort study of 101 hospitalized ESKD patients with COVID-19 from May to December 2020.
- Statistical analysis included chi-square test, t-tests, Mann-Whitney U-test, and Cox regression.
Main Results:
- COVID-19 patients with ESKD had a 19.8% mortality rate.
- Mortality risk was significantly higher in patients aged ≥ 65 years, males, and those with diabetes (RR=6.5) or cardiovascular disease (RR=3.8).
- Common symptoms included fever, shortness of breath, and cough. Septic shock and respiratory failure were leading causes of death. Elevated inflammatory markers (ferritin, D-dimer) and lower hemoglobin/platelet counts were observed in non-survivors.
Conclusions:
- COVID-19 patients with ESKD exhibit increased mortality risk, influenced by age and comorbidities like diabetes and cardiovascular disease.
- Higher levels of inflammatory markers correlate with disease severity and in-hospital mortality in this population.
- Findings highlight the need for targeted management strategies for ESKD patients during COVID-19 pandemics.
Background:
The prognosis of the novel coronavirus disease 2019 (COVID-19) may be poor in patients with end-stage kidney disease (ESKD). Limited information is available on the clinical characteristics and outcomes of such patients in Arab countries. The present study aimed to address this gap.
Methods:
This retrospective cohort study included 101 patients with ESKD who were hospitalized for COVID-19 between May 1, 2020 and December 31, 2020 at King Fahad Central Hospital (single center), Jazan Province, Saudi Arabia. Chi-square test, independent samples t-test, Mann-Whitney U-test, and Cox regression were performed in the statistical analysis.
Results:
Of the 101 hospitalized COVID-19 patients with ESKD, 20 patients died (19.8%). Patients aged ≥ 65 years had a significant mortality risk. Mortality was higher in male patients (70%) than in female patients (30%). The most common comorbidities were hypertension (88%), diabetes mellitus (47%), and heart disease (17%). The presence of diabetes and cardiovascular diseases along with ESKD increased the mortality risk [relative risk (RR) = 6.5 and RR = 3.8, respectively]. The most frequently reported clinical symptoms were fever (50%), shortness of breath (41%), and cough (35%). In total, 17% of the patients were admitted to the intensive care unit and required mechanical ventilation. Most patients had bilateral lung infiltrates (88%). Hemoglobin levels and platelet counts were significantly lower in the deceased patients than in the surviving ones. Moreover, compared with the surviving patients, higher degree of lymphocytopenia, neutrophilia, ferritin, D-dimer, blood urea nitrogen, and aspartate transaminase were detected in the deceased patients. Septic shock (20%) and respiratory failure (19%) were the most prevalent complications resulting in death.
Conclusion:
COVID-19 patients with ESKD have an increased risk of poor outcomes and mortality. The mortality risk increases with an increase in age and the presence of other comorbidities, such as diabetes and cardiovascular disease. Elevated levels of inflammatory markers correlate with disease severity and are associated with in-hospital mortality in this population.
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