COVID-19 In-Hospital Mortality in Patients with CKD

There are few data available on outcomes of coronavirus disease 2019 (COVID-19) among patients with chronic kidney disease (CKD). Oleh Akchurin, MD, and colleagues at Weill Cornell Medicine, New York New York, conducted a retrospective cohort study of patients with and without CKD consecutively admitted with COVID-19 to three affiliated hospitals in New York City. Results of the study were reported online in Kidney 360 [doi.org/10.34067/KID.0004142020].

Diagnoses of CKD pre-COVID-19 were identified using billing codes and manual chart review. The study was designed to compare in-hospital mortality between patients with and without pre-existing CKD. Adjustments for confounders and identification of patient characteristics associated with mortality were established using logistic regression.

There were 280 patients with CKD hospitalized with COVID-19 and 4098 patients without CKD hospitalized for COVID-19. In the CKD group, median age was 75 years and baseline serum creatinine was 1.5 mg/dL. In the non-CKD group, median age was 62 years.

In-hospital mortality in the CKD group was 30% compared with 19.9% in the non-CKD group (P<.001). Following adjustment for comorbidities (hypertension, diabetes mellitus, asthma, and chronic obstructive pulmonary disease), the risk of in-hospital mortality remained significantly higher in the CKD group than in the non-CKD group (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.1-1.9).

Following stratification by age, patients more than 70 years of age with CKD had higher morality than their age-matched control patients without CKD. In the CKD group, factors associated with in-hospital death were age (aOR, 1.09; 95% CI, 1.06-1.12), baseline and admission serum phosphorus (aOR, 1.5; 95% CI, 1.03-2.1 and 1.4; 95% CI, 1.1-1.7, respectively), serum creatinine on admission >0.3 mg/dL above baseline (aOR, 2.6; 95% CI, 1.2-5.4), and diagnosis of acute on chronic kidney injury during hospitalization (aOR, 4.6; 95 %CI, 2.3-8.9).

In conclusion, the researchers said, “CKD is an independent risk factor for COVID-19 associated in-hospital mortality in elderly patients. Acute on chronic kidney injury increases odds of in-hospital mortality in CKD patients hospitalized with COVID-19.”