Patients with non-dialysis CKD, COVID-19 experience worse outcomes and hospital mortality
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Patients hospitalized for COVID-19 with end-stage renal disease exhibited better outcomes than patients with non-dialysis chronic kidney disease, according to a study.
Also, crude hospital mortality from COVID-19 was highest in patients with non-dialysis CKD compared with patients who had ESRD and non-CKD. The higher crude mortality trend lost significance after researchers applied multivariate adjustments, however.
“Overall, these data support the idea that the presence of ESRD does not independently increase the risk of death or COVID-19[-]related critical illness, and that high reported mortality rates in this population are likely due to clustering of unfavorable demographics and comorbidities,” Minesh Khatri, MD, clinical assistant professor of medicine and associate program director of the nephrology fellowship at NYU Winthrop Hospital, and colleagues wrote.
Khatri and colleagues investigated whether patients with non-dialysis CKD vs. ESRD experienced different outcomes in relation to COVID-19 infection.
This observational, retrospective study included adult patients at three New York hospitals who tested positive for COVID-19 between March 2 and Aug. 27, 2020. Researchers used electronic health records and classified patients into non-CKD, non-dialysis CKD and ESRD cohorts, noting outcomes like ICU admission, mortality rates and hospital mortality.
Among the 3,905 patients, the mean age was 66 years. In addition, 60.2% were men, 36.7% had diabetes, 60.8% had hypertension and 84.2% had a major chronic condition.
Non-dialysis CKD was present in 15.1% of patients and ESRD in 3.3%. Patient cohorts with ESRD or non-CKD had a lower median age than those with non-dialysis CKD. The non-dialysis CKD and ESRD cohorts had higher rates of Black patients, smoking histories and comorbidities like diabetes, hypertension and heart disease. However, the ESRD cohort had less obesity and more hypotension than the non-CKD group.
The researchers observed a trend toward reduced mortality in all three cohorts as the pandemic continued beyond the first 2 months. However, the overall unadjusted hospital mortality was 25.2% — 23.6% among the non-CKD group, 33.5% for the non-dialysis CKD group and 27.3% for the ESRD cohort. AKI occurred more often in patients with non-dialysis CKD compared with those without CKD (57.3% vs. 27.8%). ICU admission was similar across the three groups.
Researchers reasoned their findings “underscore the importance of demographics and comorbidities as greater determinants of COVID-19 outcomes.”
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