QJM. 2020 Aug 25:hcaa258. doi: 10.1093/qjmed/hcaa258. Online ahead of print.
BACKGROUND: Patients on dialysis were susceptible to COVID-19 and were prone to severe clinical characteristics after infection; acute kidney injury was related to mortality in COVID-19 cases. Limited is known about the characteristics of COVID-19 patients with end-stage renal disease not requiring renal replacement therapy (RRT).
AIM: Evaluate clinical characteristics, course and outcomes of COVID-19 patients with chronic kidney disease (CKD) who did not require RRT and those on dialysis.
DESIGN: A two-center retrospective study.
METHODS: 836 adult patients with COVID-19 (24 CKD not on dialysis; 15 dialysis-dependent CKD) were included. The study includes no patients with renal transplantation. Risk factors were explored.
RESULTS: CKD not requiring RRT is an independent risk factor for in-hospital death [adjusted OR (aOR) 7.35 (95%CI 2.41-22.44)] and poor prognosis [aOR 3.01 (95%CI 1.23-7.33)]. Compared to COVID-19 cases without CKD, those with CKD not requiring RRT showed similar percentage of initial moderate cases (75.00% vs. 73.65%) but higher incidence of in-hospital neutrophilia (50.00% vs. 27.30%) or death (50.00% vs. 9.03%). The odds ratio of dialysis associated to mortality in CKD patients was 2.00 (95%CI 0.52-7.63), suggesting COVID-19 patients with dialysis-dependent CKD were at greater risk of in-hospital death. For COVID-19 patients with CKD not requiring RRT, statins reduced the risk of neutrophilia [OR 0.10 (95%CI 0.01-0.69)] while diuretics increased the risk of neutrophilia [OR 15.4 (95%CI 1.47-160.97)], although both showed no association to mortality.
CONCLUSION: COVID-19 patients with CKD presented high incidence of neutrophilia, poor prognosis and in-hospital death, with dialysis patients being more vulnerable.