More severe CKD increases risk for poor COVID-19 outcomes with type 2 diabetes
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SAN DIEGO — Adults with type 2 diabetes hospitalized with COVID-19 are more likely to be admitted to the ICU, require mechanical ventilation or die if they have more advanced chronic kidney disease, according to a speaker.
According to data published in Preventing Chronic Disease, adults with complications from diabetes hospitalized with COVID-19 have a 26% higher risk for mortality, and those with CKD have a 21% higher risk for death from COVID-19 compared with healthy adults. Additionally, the risk for COVID-19 gradually increases with the number of comorbid conditions; adults with two to five comorbidities have a 2.6 times higher risk for death compared with those with no comorbidities.
“The combined effect of CKD and diabetes on mortality risk had not yet been evaluated in those hospitalized with COVID-19,” Ella Burguera-Couce a second-year medical student at Warren Alpert Medical School of Brown University, said during a presentation. “As such, the objective of our study is to evaluate the impact of CKD stages on health outcomes in hospitalized individuals with type 2 diabetes admitted with COVID-19.”
Burguera-Couce and colleagues analyzed data on 1,122 adults with type 2 diabetes hospitalized with COVID-19 in Lifespan Health System in Rhode Island from March 2020 to February 2021. People with estimated glomerular filtration rate recorded at admission were included in the analysis. Multivariate logistic regression analysis was used to compare CKD stages with adverse outcomes, including length of hospital stay of 1 week or longer, ICU admission, mechanical ventilation and in-hospital mortality.
Of the study cohort, 50.5% had stage 1, 2 or 3A CKD, 18.8% had stage 3B CKD, 16.3% had stage 4 CKD and 14.4% had stage 5 CKD. Length of hospitalization increased with worsening CKD stage. Those with stage 5 CKD had an average mean hospitalization of 15 days compared with 8 days in the group with stage 1, 2 or 3A CKD (P < .0001).
The percentage of patients experiencing adverse COVID-19 outcomes increased with each CKD stage. Of those with stage 5 CKD, 29% died in the hospital compared with 21% of the stage 4 group, 11% of the stage 3B group, and 4% of those with stage 1, 2 or 3A CKD. Of the stage 5 CKD group, 34% were admitted to the ICU compared with 25% of the stage 4 group, 17% of the stage 3B group and 11% of those with stage 1, 2 and 3A CKD. A similar pattern was seen with mechanical ventilation, with 29% of those with stage 5 CKD requiring mechanical ventilation compared with 18% of those with stage 4 CKD, 7% of those with stage 3B CKD and 5% of those with stage 1, 2 and 3A CKD.
In multivariate analysis, adults with stage 5 CKD had a higher risk for poor COVID-19 outcomes compared with those with stage 1, 2 or 3A CKD (OR = 4.67; 95% CI, 2.25-9.71). A higher risk for adverse outcomes was also observed for adults with hyperglycemia at admission compared with those with no hyperglycemia (OR = 10.49; 95% CI, 3.09-35.6) and those hospitalized during the first wave of COVID-19 (OR = 2.22; 95% CI, 1.02-4.83) compared with later waves.
“In individuals with type 2 diabetes hospitalized with COVID-19, advanced CKD stages were associated with severe outcomes, resulting in ICU admission, mechanical ventilation, longer length of stay and in-hospital mortality, with risks increasing with worsening CKD,” Burguera-Couce said. “Our data suggest that the combination of progressive CKD and type 2 diabetes amplifies their individual impact on COVID-19 risk by magnitudes.”
Reference:
Kompaniyets L, et al. Prev Chronic Dis. 2021;doi:10.5888/pcd18.210123.
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Burguera-Couce E, et al. Outcomes in hospitalized COVID-19 patients with type 2 diabetes and chronic kidney disease. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 12-14, 2022; San Diego.
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