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The Role of Kidney Function in Predicting COVID-19 Severity and Clinical Outcomes: A Retrospective Analysis
Victor Muniz de Freitas1, Érika Bevilaqua Rangel1,2
1Department of Medicine, Nephrology Division, Federal University of São Paulo, Borges Lagoa Street, 783, 6th Floor, Vila Clementino, São Paulo 04038-031, SP, Brazil.
Insights
Reduced kidney function (eGFR < 60) in COVID-19 patients significantly increases mortality risk and the need for intensive care. This simple measure can help identify high-risk individuals early.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 presents complex immune dysregulation, cytokine storm, endothelial injury, and thrombosis.
- Kidney function is increasingly recognized as a critical factor in COVID-19 severity.
- Understanding the impact of renal impairment on COVID-19 outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the influence of kidney function on clinical, laboratory, and outcome parameters in hospitalized COVID-19 patients.
- To determine if estimated glomerular filtration rate (eGFR) can serve as an early risk stratification tool.
- To identify specific clinical and laboratory differences between COVID-19 patients with varying eGFR levels.
Main Methods:
- Retrospective analysis of 359 COVID-19 patients during the initial pandemic wave.
- Stratification based on estimated glomerular filtration rate (eGFR < 60 vs. ≥60 mL/min/1.73 m²).
- Collection and analysis of demographic, vital sign, laboratory, and clinical outcome data, including mortality, hemodialysis, ICU admission, and mechanical ventilation, using regression and ROC analyses.
Main Results:
- Patients with eGFR < 60 were older and had more comorbidities (hypertension, CKD, transplantation history, immunosuppression).
- Lower eGFR group exhibited significantly higher mortality (41.6% vs. 19.2%), hemodialysis (32.3% vs. 9.6%), ICU admission (50.9% vs. 37.9%), and mechanical ventilation (39.8% vs. 21.2%) rates.
- Laboratory findings in the low eGFR group included acidosis, anemia, lymphopenia, elevated inflammatory markers, and hyperkalemia.
Conclusions:
- Admission eGFR < 60 mL/min/1.73 m² is strongly associated with adverse clinical outcomes in COVID-19 patients.
- Reduced kidney function serves as a simple and effective early marker for risk stratification in hospitalized COVID-19 cases.
- Early identification of patients with impaired kidney function can guide proactive management strategies and resource allocation.
Abstract:
Background: Coronavirus disease 2019 (COVID-19) involves a complex interplay of dysregulated immune responses, a pro-inflammatory cytokine storm, endothelial injury, and thrombotic complications. This study aimed to evaluate the impact of kidney function on clinical, laboratory, and outcome parameters in patients hospitalized with COVID-19. Methods: We conducted a retrospective analysis of 359 patients admitted during the first wave of COVID-19, stratified by estimated glomerular filtration rate (eGFR < 60 vs. ≥60 mL/min/1.73 m2). Data on demographics, vital signs, laboratory values, and clinical outcomes-including mortality, hemodialysis requirement, intensive care unit (ICU) admission, and mechanical ventilation (MV)-were collected. Univariate and multivariate linear regression, as well as area under the receiver operating characteristic curve (AUC-ROC) analyses, were performed. A p-value < 0.05 was considered statistically significant. Results: Patients with an eGFR < 60 were older and more likely to have systemic hypertension, chronic kidney disease, a history of solid organ transplantation, and immunosuppressive therapy. This group showed higher rates of mortality (41.6% vs. 19.2%), hemodialysis requirement (32.3% vs. 9.6%), ICU admission (50.9% vs. 37.9%), and MV (39.8% vs. 21.2%). Laboratory results revealed acidosis, anemia, lymphopenia, elevated inflammatory markers, and hyperkalemia. Conclusions: An admission eGFR < 60 mL/min/1.73 m2 is associated with worse clinical outcomes in COVID-19 and may serve as a simple, early marker for risk stratification.
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