COVID-19 Prognosis in Patients with Underlying CKD and Kidney Related Complications

Abstract

Introduction: In December 2019, a novel RNA virus causing COVID-19, a respiratory illness that can lead to diffuse alveolar damage and respiratory failure, was reported. The virus facilitates host cell entry through angiotensin-converting enzyme-2 (ACE2) receptor which is present in many organs including kidneys. Kidney injury, including acute kidney injury (AKI), proteinuria and hematuria, has been a reported in COVID-19 patients. The extent of renal involvement has not been extensively correlated with prognosis and outcomes in COVID-19 patients. Methods: Retrospective chart review including patients aged 18 years and older, admitted to a community hospital from March 15, 2020 to April 15, 2020, testing positive for COVID-19. Patient characteristics on admission were collected which included presence of AKI, hematuria, proteinuria and underlying CKD stage, if any. Outcomes included intubation rate, ICU admission, length of stay and inpatient-mortality. Continuous variables were compared using independent t-test. Chi-square test was used to test relationships between categorical variables. Results: A total of 212 charts were studied. After removing missing data, 186 patients were included. 22.6% (n=42) had moderate-severe underlying CKD (stage 3 or more). 38.7% (n=72) of total patients had AKI on presentation. Urinalysis was not done in 51 patients, so of the rest 135 patients, 55.6% (n=75) had hematuria and 52.6% (n=71) had proteinuria on admission. Inpatient mortality was found to be significantly higher in patients with underlying moderate-severe CKD compared to those who did not (52.4% vs 31.3%, p=0.012). Patients with hematuria on admission had significantly higher rates of intubation (37.3% vs 20%, p=0.028) and ICU admissions (44% vs 26.7%, p=0.037) compared to those who did not have hematuria on admission. Length of stay was also significantly higher in patients who had hematuria on admission compared to those who did not (10±8 vs 7±6 days, p=0.042). AKI and proteinuria on admission resulted in no significant difference in intubation, ICU admission, length of stay, or inpatient mortality. No significant difference in length of stay, intubation, and ICU admission was found in patients with underlying mod-severe CKD compared to those who didn't. Conclusion: Early renal involvement and underlying CKD worsen the prognosis of COVID-19 pneumonia and result in higher mortality outcomes. Such patients, especially those with findings of hematuria on admission, need closer monitoring. Furthermore, many COVID-19 patients receive steroids and anticoagulants as part of treatment regimen which will need to be further evaluated as these therapies may contribute to further damage of the kidneys.