Sequels of COVID-19 in nephrology. Chronic kidney patients are more prone to hemodialysis need and mortality

Abstract

Introduction: Acute kidney injury involves inflammation and intrinsic renal damage, and is a common complication of severe coronavirus disease 2019 (COVID-19). Baseline chronic kidney disease (CKD) confers an increased mortality risk. We determined the renal long-term outcomes of COVID-19 in patients with baseline CKD, and the risk factors prompting renal replacement therapy (RRT) initiation and mortality.

Methodology: We included 77 patients (median age was 67.1 ± 13.7 years) with a history of renal failure at baseline and recovery from COVID-19 at our institution, in a retrospective analysis from December 2020 to May 2021. Demographic, clinical, and laboratory data were compared between patients requiring RRT and those who did not. A correlogram analysis determined the risk factors for RRT. Survival analysis using the Kaplan-Meier method and Cox regression statistics assessed in-hospital mortality.

Results: 70.1% of the patients had CKD. RRT initiation was higher in patients with known CKD (46.4%) than in those with no known CKD (28.5%). Those with diabetic nephropathy had a higher predisposition for RRT initiation compared to other CKD etiologies. Diabetics (42.3%) and hypertensive nephropathy (33%) were the most common etiologies in the general population. Blood urea nitrogen (BUN), creatinine, phosphorus, lactate dehydrogenase, and proteinuria were significantly higher; and platelets and calcium levels were lower; in patients requiring RRT. Decreased lymphocyte count negatively correlated with BUN levels.

Conclusions: Known CKD patients had a higher initiation rate of RRT, and laboratory features suggestive of kidney damage. However, RRT patients did not have an increased risk of mortality.