Relationship between diabetes mellitus and covid-19 prognosis in kidney transplant patients

Purpose: A high number of comorbidities associated with the severity of the disease caused by SARS-CoV-2 (COVID-19) has been reported, such as systemic arterial hypertension (SAH), diabetes mellitus (DM), cerebrovascular and cardiovascular diseases, obesity, chronic kidney disease, among others. Importantly, poor glycemic control in diabetic individuals and hyperglycemia at admission are associated to COVID-19 progression. To evaluate whether kidney transplant recipients with DM have worse outcomes in COVID-19 setting when compared to non-diabetics, as well as to verify whether the poor glycemic control contributes to COVID-19 progression. Methods: Retrospective analyses of 590 kidney transplant recipients who were diagnosed with COVID-19 at one single Brazilian center. We used DM, SAH and poor glycemic control as dependent variables in univariate analyses to determinant the risk factors for COVID-19 progression. Results: 60% male, 64.4% white, average age 51.6 years-old, 192 (32.6%) DM and 158 (26.8%) SAH. COVID-19-related symptoms included: fever (63.4%), chills (63.4%), cough (60.3%), dyspnea (49.3%), myalgia (46.3 %), diarrhea (32.4%), anosmia (31.2%), headache (23.7%) and runny nose (21.7%). DM was associated with acute respiratory distress syndrome (ARDS) (P=0.0001), use of supplemental oxygen (P=0.001), intensive care unit (ICU) admission (P=0.0001), mechanical ventilation (MV) (P=0.001), acute graft dysfunction (P=0.0001), hemodialysis (P=0.009), and death (P=0.0001). Fasting blood glucose prior to hospitalization was related to the risk of death (130 vs 112 mg/dL, P=0.002), MV (130 vs 119 mg/ dl, P=0.0001) and ICU admission (127 vs 109 mg/dl, P=0.0001). HbA1c values were associated with the risk of MV (7.2 vs 6.9%, P =0.031) and ICU admission (7.1 vs 6.6%, P=0.025). SAH was associated with ARDS (P=0.044), ICU admission (P=0.028), MV (P=0.018), graft dysfunction (P=0.006), HD (P=0.007) and death (P=0.037). ACE inhibitors or ARBs were not associated with the risk of death (P=0.792 and P=0.138, respectively). Conclusions: DM and poor glycemic control, as well as SAH were associated with worse outcomes in COVID-19. These findings highlight the importance of adequate management of comorbidities in transplant patients, especially in relation to DM, since poor glycemic control contributes to the worst outcomes in COVID-19. ACE inhibitors and ARBs should not be discontinued during COVID-19 pandemic, as they do not increase the risk of death.