Abstract
The aim of the study was to investigate the role of chronic kidney disease (CKD) on in-hospital mortality and on incident atrial fibrillation (AF) in patients infected with SARS-CoV-2. The incidence of acute kidney injury (AKI) was also investigated. Multivariable regression models were used to assess the association between renal function groups (estimated Glomerular Filtration Rate, eGFR, >60 mL/min, 30–59 mL/min, <30 mL/min) and in-hospital all-cause mortality and incident AF and AKI. A cohort of 2816 patients admitted in one year for COVID-19 disease in two large hospitals was analyzed. The independent predictors of mortality were severe CKD [HR 1.732 (95%CI 1.264–2.373)], older age [HR 1.054 (95%CI 1.044–1.065)], cerebrovascular disease [HR 1.335 (95%CI (1.016–1.754)], lower platelet count [HR 0.997 (95%CI 0.996–0.999)], higher C-reactive protein [HR 1.047 (95%CI 1.035–1.058)], and higher plasma potassium value 1.374 (95%CI 1.139–1.658). When incident AKI was added to the final survival model, it was associated with higher mortality [HR 2.202 (1.728–2.807)]. Incident AF was more frequent in patients with CKD, but in the multivariable model only older age was significantly related with a higher incidence of AF [OR 1.036 (95%CI 1.022–1.050)]. Incident AF was strongly associated with the onset of AKI [HR 2.619 (95%CI 1.711–4.009)]. In this large population of COVID-19 patients, the presence of severe CKD was an independent predictor of in-hospital mortality. In addition, patients who underwent AKI during hospitalization had a doubled risk of death. Incident AF became more frequent as eGFR decreased and it was significantly associated with the onset of AKI.
Highlights
IntroductionSince COVID-19, caused by the severe acute respiratory syndrome coronavirus 2
Licensee MDPI, Basel, Switzerland.Since COVID-19, caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), was discovered and evolved into a pandemic, it has become a source of interest for numerous studies [1,2]
Chronic kidney disease patients were older than those with estimated glomerular filtration rate (eGFR) > 60 mL/min and the number of comorbidities increased as renal function decreased
Summary
Since COVID-19, caused by the severe acute respiratory syndrome coronavirus 2. (SARS-CoV-2), was discovered and evolved into a pandemic, it has become a source of interest for numerous studies [1,2]. The SARS-CoV-2 infection was considered to compromise lung function only, but subsequently, several studies showed that many other organs could be involved, the kidneys in particular [3,4]. The main symptoms of SARS-CoV-2 infection are observed 2–14 days after exposure. A severe complication of the disease is progressive respiratory failure, and death may occur in 3.4% of the infected patients [6]. Chronic kidney disease (CKD) has been shown to be a comorbidity associated with reduced survival in patients hospitalized for COVID-19 disease [7,8]
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