Researchers in the UK predict COVID-19 burden on patients with CKD using pre-pandemic data
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Using a prediction model and electronic health records from before the pandemic, researchers estimated the burden that COVID-19 would have on patients with chronic kidney disease in the United Kingdom.
“During the coronavirus (COVID-19) pandemic, CKD has been associated with poor prognosis. Despite clinical and public health importance, CKD research to date in all stages, multimorbidity or the general population using national-level data has been limited,” Ashkan Dashtban, PhD, form the Institute of Health Informatics at the University College London in the United Kingdom, and colleagues wrote. “Using national, population-based [EHR], in individuals with prevalent and incident CKD, we investigated: (1) underlying conditions; (2) mortality risk; (3) incidence of SARS-CoV-2 infection and (4) prediction and validation of pandemic-related excess deaths.”
In a retrospective, population-based cohort study, researchers examined data for patients with prevalent CKD (n= 1,934,585) and incident CKD (n= 144,969) in England. Researchers measured patients’ baseline mortality risk, incidence and outcome of infection by comorbidities and controlled for age, sex and vaccination.
Researchers defined “prevalent CKD” in patients who had CKD for at least 6 months prior to the onset of pandemic (March 1, 2020) without prior history of COVID-19, and “incident CKD” as new onset from March 1, 2020, to March 1, 2021, in patients without a history of COVID-19 prior to developing CKD.
Using a new prediction model and EHR data from before the pandemic, researchers estimated the burden of COVID-19 among patients with CKD in the U.K.
Analyses revealed comorbidities and multimorbidity were frequent (73.5% and 71.2% with one or more condition(s) in respective data sets, and 13.2% and 11.2% with three or more conditions, in prevalent and incident CKD), and correlated with COVID-19 infections and severe COVID-19. Additionally, 1-year mortality risk was high and depended on age, underlying conditions, CKD stage and incidence or prevalence of CKD, ranging from 0.5% to 37.2%.
Of the 34,265 observed excess deaths in the National Health Service Digital Trusted Research Environment and Clinical Practice Research Datalink databases, researchers predicted 28,746 and 24,546 deaths (infection rates 10% and relative risks 3), and 23,754 and 20,283 deaths (observed infection rates 6.7% and relative risks 3.7), respectively.
“In conclusion, individuals with CKD have high burden of multimorbidity and high risk of pre-pandemic mortality across all stages of CKD and in prevalent and incident disease. We showed that the direct burden of pandemic could be predicted using pre-pandemic, large-scale EHR data,” Dashtban and colleagues wrote. “The combined data for multimorbidity, CKD stage, and age could help prioritize patients for vaccination and post-COVID policies and design of stratified pathways for CKD patients.”
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