Introduction
The CKD5D patients with reduction in kidney function are vulnerable to COVID-19–related critical illness, marked by multisystem organ failure, thrombosis, and a heightened inflammatory response. Understanding the outcomes of COVID-19–infected patients with and without ESRD is important because this information would help risk-stratify patients with ESRD to certain therapies for COVID-19 as they arrive at the hospital.
Methods
This prospective observational study enrolled first thirty CKD5D patients hospitalised with COVID-19 infection and compared their clinico-laboratory profile and outcomes in terms of mortality or discharge or time to COVID negative, with thirty non-CKD patients with COVID-19 infection admitted at our hospital.
Results
Total of sixty COVID-19 infected patients were analysed, thirty with CKD5D status and thirty were non-CKD patients. The mean age was lesser among CKD5D patients (50.70 years). The most common comorbidity was hypertension (83.33% in CKD5D patients and 70% in non-CKD group) followed by diabetes mellitus (70% in CKD5D patients and 50% in non-CKD patients) in both the groups. There was no significant difference between the two groups based on the comorbidity profile. The proportion of patients with CKD 5D having dysgeusia (60% vs 16.67%) and anosmia (53.33% vs 16.67%) was significantly higher compared to the non-CKD group of patients. The most common symptom being cough in both the CKD 5D (73.33%) and non-CKD (83.33%) group. The proportion of patients with moderate disease was significantly higher in the CKD patients (50% vs 10%). There was no significant difference in terms of Neutrophil-Lymphocyte ratio. The mean levels of serum ferritin and D dimer were slightly higher for the non-CKD group whereas the average IL-6 levels were higher for the CKD 5D groups of patients (329.7 pg/ml vs 30.74 pg/ml in non-CKD patients). Mortality was higher in the CKD 5D group (33.33% in CKD5D vs 23.33% in non-CKD, p=0.3940). The higher proportion of patients were discharged without deterioration in the non-CKD group (66.67% vs 53.33% in CKD5D, p= 0.2957). The mean duration to discharge or death was significantly higher for the CKD 5D group (27.10 days vs 16.20 days, P=0.0004) with a higher duration of hospital stay for the CKD 5D patients ranging from 8 to 58 days. The CKD5D patients needed 26±11.14 days to turn COVID negative and recover, significantly higher than 15.39±7.79 days among non-CKD patients. Among CKD5D patients, the higher IL-6 and D-dimer levels were associated with increased severity of COVID-19. The CKD 5D patients with higher D-dimer levels (977.5 vs 574.5 ng/ml, P<0.01) required critical care with ICU stay and higher support of ventilations. A higher IL-6 (894.27 vs 47.41pg/ml, P=0.0214), NL ratio (12.35 vs 5.03, P=0.0013) and lower lymphocyte count (9.70/uL vs 19.50/uL) was significantly associated with increased mortality when compared to those recovered.
Conclusions
The CKD stage 5 patients on dialysis took significantly longer time to clear SARS-Cov-2 with a mean of 26 days. Mortality was particularly high in CKD 5D patients with severe COVID-19. Among the hospitalised COVID-19 patients, the CKD 5D status had higher adjusted odds ratio (aOR) for mortality of 3.3; 3.2 and 7.19 when adjusted for age and gender; age and comorbidities (hypertension and diabetes mellitus) and age, biochemical and inflammatory markers respectively.
No conflict of interest