Outcomes Among Hospitalized Chronic Kidney Disease Patients with COVID-19

Background: Chronic kidney disease (CKD) patients have impaired immunity, increased risk of infection-related mortality, and worsened COVID-19 outcomes. However, data comparing non-dialysis CKD and end stage renal disease (ESRD) are sparse. Methods: Patients with COVID-19 admitted to three New York area hospitals between March 2 and August 27, 2020 were retrospectively studied using electronic health records. Patients were classified as non-CKD, non-dialysis CKD, and ESRD, with outcomes including hospital mortality and ICU admission and mortality rates. Results: Of 3,905 patients, 588 (15.1%) had non-dialysis CKD and 128 (3.3%) had ESRD. Non-dialysis CKD and ESRD groups had a greater prevalence of comorbidities and higher admission d-dimer levels, while ESRD patients had lower admission C-reactive protein levels. ICU admission rates were similar across all three groups (23-25%). Overall unadjusted hospital mortality was 25.2%, and was 23.6% for non-CKD, 33.5% for non-dialysis CKD, and 27.3% for ESRD. Among ICU patients, mortality was 56.1%, 63.5% and 56.3%, respectively. While non-dialysis CKD patients had higher odds of overall mortality versus non-CKD in univariate analysis (OR 1.58, 95% CI 1.31-1.91), this was no longer significant in fully adjusted models (OR 1.11, 95% CI 0.88-1.40). ESRD status also did not associated with a higher risk of mortality compared to non-CKD in adjusted analyses, but did have reduced mortality when compared to non-dialysis CKD (OR 0.57, 95% CI 0.33-0.95). Mortality rates declined precipitously after the first two months of the pandemic, from 26.3% to 14.4%, which was reflected in all three subgroups. Conclusions: In a diverse cohort of COVID-19 patients, we observed higher crude mortality rates for patients with non-dialysis CKD, and to a lesser extent ESRD, that were not significant after risk adjustment. Moreover, patients with ESRD appear to have better outcomes than those with non-dialysis CKD.