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Outcomes among Hospitalized Chronic Kidney Disease Patients with COVID-19
Minesh Khatri1, David M Charytan2, Sam Parnia2
1New York University Long Island School of Medicine, Mineola, New York.
Insights
Patients with chronic kidney disease (CKD) face higher COVID-19 mortality risks. End-stage kidney disease (ESKD) patients showed better outcomes than those with non-dialysis CKD, contrary to initial observations.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Chronic kidney disease (CKD) impairs immunity, increasing infection risks and worsening COVID-19 outcomes.
- Limited data exists comparing COVID-19 outcomes between non-dialysis CKD and end-stage kidney disease (ESKD).
Purpose of the Study:
- To compare COVID-19 outcomes, including mortality, across patients without CKD, with non-dialysis CKD, and with ESKD.
- To investigate the association between CKD stages and COVID-19 related mortality after risk adjustment.
Main Methods:
- Retrospective study of 3905 patients with COVID-19 admitted to New York hospitals (March-August 2020).
- Patients were categorized into non-CKD, non-dialysis CKD, and ESKD groups.
- Outcomes analyzed included hospital mortality, ICU admission, and mortality rates, with adjustments for confounders.
Main Results:
- Crude mortality was higher in non-dialysis CKD (34%) and ESKD (27%) groups compared to non-CKD (24%).
- After risk adjustment, neither non-dialysis CKD nor ESKD significantly increased overall mortality risk compared to non-CKD.
- ESKD patients demonstrated reduced mortality compared to non-dialysis CKD patients (OR, 0.57; 95% CI, 0.33 to 0.95).
Conclusions:
- While crude mortality is higher in CKD patients, risk adjustment mitigates this association.
- End-stage kidney disease (ESKD) patients appear to have better COVID-19 outcomes than those with non-dialysis CKD.
- Mortality rates for all groups declined significantly over the study period.
Background:
Patients with CKD ha ve impaired immunity, increased risk of infection-related mortality, and worsened COVID-19 outcomes. However, data comparing nondialysis CKD and ESKD are sparse.
Methods:
Patients with COVID-19 admitted to three hospitals in the New York area, between March 2 and August 27, 2020, were retrospectively studied using electronic health records. Patients were classified as those without CKD, those with nondialysis CKD, and those with ESKD, with outcomes including hospital mortality, ICU admission, and mortality rates.
Results:
Of 3905 patients, 588 (15%) had nondialysis CKD and 128 (3%) had ESKD. The nondialysis CKD and ESKD groups had a greater prevalence of comorbidities and higher admission D-dimer levels, whereas patients with ESKD had lower C-reactive protein levels at admission. ICU admission rates were similar across all three groups (23%-25%). The overall, unadjusted hospital mortality was 25%, and the mortality was 24% for those without CKD, 34% for those with nondialysis CKD, and 27% for those with ESKD. Among patients in the ICU, mortality was 56%, 64%, and 56%, respectively. Although patients with nondialysis CKD had higher odds of overall mortality versus those without CKD in univariate analysis (OR, 1.58; 95% CI, 1.31 to 1.91), this was no longer significant in fully adjusted models (OR, 1.11; 95% CI, 0.88 to 1.40). Also, ESKD status did not associate with a higher risk of mortality compared with non-CKD in adjusted analyses, but did have reduced mortality when compared with nondialysis CKD (OR, 0.57; 95% CI, 0.33 to 0.95). Mortality rates declined precipitously after the first 2 months of the pandemic, from 26% to 14%, which was reflected in all three subgroups.
Conclusions:
In a diverse cohort of patients with COVID-19, we observed higher crude mortality rates for patients with nondialysis CKD and, to a lesser extent, ESKD, which were not significant after risk adjustment. Moreover, patients with ESKD appear to have better outcom es than those with nondialysis CKD.
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