CKD Linked With COVID-19 Severity in Older Patients

Chronic kidney disease (CKD) significantly heightens the risk of intensive care unit (ICU) admission and in-hospital mortality among older patients who contract COVID-19, according to a new report.

The study, published in the International Journal of Clinical Practice, uses information from a database including patients who sought care at Turkish medical centers between April and December 2020.

Corresponding author Mustafa Arici, MD, of the Hacettepe University Faculty of Medicine, and colleagues, noted that CKD is a common disease in older adults and some existing evidence has suggested that those with COVID-19 have different clinical presentations and outcomes.

Arici and colleagues wanted to look not just at overall outcomes, but also at the experiences of different disease groups.

They used the Turkish Society of Nephrology’s database to identify patients over the age of 18 who were diagnosed with stage 3-5 CKD (CKD group) or who were on maintenance hemodialysis (HD). From there, the investigators divided the patients based on age, separating out “older” patients with CKD which was defined as those at least 65 years old.

The database yielded a total of 879 patients, with a median age of 63. A total of 273 patients with CKD were included, of whom 188 were at least 65 years old. The HD group consisted of 306 patients, of whom 150 were in the older cohort. Finally, a control group of non-uremic hospitalized patients were also included. Seventy of the 300 control patients were 65 or older.

Their analysis revealed a strong correlation.

“These results clearly show that older patients with severe chronic kidney disease, whether on dialysis or not, are among the most affected patient groups in the COVID-19 pandemic,” Arici and colleagues wrote.

Among older patients, the percentage of those with stage 3-5 CKD who presented with severe or critical COVID-19 was 43.6%. The rate was even higher, at 55.3%, in the HD group. In the control group, the rate of severe or critical COVID-19 at presentation was just 16.1%.

ICU admission rates were similarly affected by CKD. More than a third of older patients in the CKD and HD groups (38.8% and 37.3%, respectively) were admitted to the ICU with COVID-19, versus 15.7% in the control group. A multivariate analysis further showed that patients in the CKD and HD groups had higher risks of in-hospital mortality compared with the control group (hazard ratio [HR] 4.33; 95% confidence interval [CI], 1.53-12.26 for the CKD group and HR 3.09; 95% CI, 1.04-9.17 for the HD group).

Though the exact questions in this study had not previously been examined, Arici and colleagues said their findings align with previous research into patients with COVID-19 and kidney disease. They said there are a number of potential reasons for the links.

“CKD and HD patients have many negative risk factors (uremic immunosuppression, volume load, toxic effects of drugs and metabolites, etc.), and these patients live with diseases (hypertension, diabetes mellitus, etc.) that cause cardiovascular disease burden for many years,” they wrote. “Cardiovascular mortality of dialysis patients is 10 to 30 times higher than the general population. Infection is the second leading cause of death among dialysis patients, after cardiovascular disease.”

The investigators concluded that physicians treating patients with COVID-19 and kidney disease should take a particularly careful approach, especially if the patients are older.

Reference:

Ozturk S, Turgutalp K, Arici M, et al. Characteristics and outcomes of hospitalized older patients with chronic kidney disease and COVID-19: a multicenter nationwide controlled study. Int J Clin Pract. Published online June 4, 2021. doi:10.1111/ijcp.14428