Pre-existing kidney disease linked to worse outcomes for patients with COVID-19
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A study of patients who were hospitalized with COVID-19 showed those with pre-existing kidney disease experienced worse outcomes, including increased mortality.
Further findings suggested worse outcomes for patients with end-stage kidney disease who received dialysis vs. those with nondialysis-dependent chronic kidney disease.
“Data from the United States (U.S.) indicate that patients with critical COVID-19 illness complicated by acute kidney injury (AKI) have worse outcomes than those without AKI,” Jennifer E. Flythe, MD, MPH, of the University of North Carolina Kidney Center, and colleagues wrote.
However, the researchers argued, while previous studies have demonstrated poor outcomes in patients with COVID-19 and pre-existing kidney dysfunction, the sample sizes were limited and many did not compare outcomes with patients who did not have pre-existing kidney complications.
“Given the rapidly changing landscape of COVID-19 therapeutics and potential for impaired kidney function to limit therapeutic options (eg, remdesivir), granular, broadly representative data characterizing clinical courses of critically ill patients with COVID-19 and pre-existing kidney disease are needed to inform management of this vulnerable population,” they wrote.
To investigate, Flythe and colleagues included 4,264 patients who were admitted to ICUs at 68 hospitals in the United States. The study population consisted of 153 patients on dialysis, 521 with CKD and 3,600 patients without kidney disease.
Investigators found patients who received dialysis had shorter time from symptom onset to ICU admission compared to both those with CKD and those without pre-existing kidney disease (median of 4 days for those on dialysis and 7 days for the other groups). In addition, 25% of patients on dialysis reported altered mental status vs. 20% for those with CKD and 12% for those with no kidney disease.
While the researchers determined the leading contributing cause of death across all patient groups to be respiratory failure, they observed increased mortality for patients with kidney disease. More specifically, approximately half of patients on dialysis and those with CKD died within 28 days of ICU admission compared with 35% of those without kidney disease.
“These findings not only highlight the importance of discussing COVID-19 risks with both dialysis and CKD patients, but also engaging in advanced care planning conversations in the ambulatory setting, prior to patients falling ill with COVID-19,” Flythe and colleagues concluded of the findings. “These discussions are particularly germane for individuals with kidney disease since remdesivir, one of the few evidence-based COVID-19 therapeutic options currently available, is generally not recommended for adults with an eGFR [less than] 30 mL/min/1.73m2.”
Therefore, the researchers contended it is crucial to pursue and develop therapies specifically targeted for patients with pre-existing kidney disease.
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