Abstract
Background There is very little published data on outcomes of COVID-19 among chronic kidney disease (CKD) patients. We compared the outcomes of COVID-19 in a tertiary care renal hospital among CKD V patients on hemodialysis (HD), peritoneal dialysis (PD), and dialysis initiation, in terms of duration of hospitalization, in-patient mortality, and 30-day mortality. Methods A total of 436 CKD V patients, on either HD, PD, or dialysis initiation, with COVID-19 who were admitted at the National Kidney and Transplant Institute (NKTI) from March 13, 2020, to August 31, 2020, were included. Kaplan–Meier survival analysis was performed. Comparison of probability of mortality by group was performed using Log-Rank test. p values ≤0.05 were considered statistically significant. Results Among 436 CKD V patients, 298 (68%) were on HD, 103 (24%) were on PD, and 35 (8%) required dialysis initiation. Overall in-hospital mortality was 34%; 38% were on HD, 20% on PD, and 37% on dialysis initiation. Total 30-day mortality was 27%; 32% were on HD, 26% on PD, and 16% on dialysis initiation. Median follow-up was 24 days. Among the 137 deaths recorded, total median time to death was 10 days; 8.5 days, 15.5 days, and 9 days for HD, PD, and dialysis initiation groups, respectively. Probability of mortality was significantly higher in HD patients versus PD patients (p < 0.00001) and in the dialysis initiation group compared to PD patients (p=0.0234). Mortality probability, however, was not significantly different in HD patients versus the dialysis initiation group (p=0.63). Conclusion Among CKD V patients diagnosed with COVID-19 at the NKTI, those on HD and on dialysis initiation had significantly higher in-hospital and 30-day mortality, compared to patients on PD.
Highlights
Introduction e pandemic of COVID19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread to the Philippines on January 30, 2020, when the first case was confirmed in Metro Manila [1]. e first local case was confirmed on March 5, 2020 [2].Various studies have described the clinical characteristics and outcomes of chronic kidney disease (CKD) patients with COVID-19
Guan et al reported in China that among patients with COVID-19 with serum creatinine ≥133 μmol/liter, 4.3% had severe disease and 9.6% reached the primary endpoint of admission to the intensive care unit (ICU), use of mechanical ventilation, or death [3]
E most common cause of primary kidney disease was diabetes mellitus (DM) (33%). ere was no significant difference across the 3 groups in terms of DM, hypertension, and chronic glomerulonephritis (CGN)
Summary
Among 436 patients included in the study, 298 (68%) were on HD, 103 (24%) were on PD, and 35 (8%) were on dialysis initiation. A significantly higher proportion of patients requiring dialysis initiation had other causes of primary kidney disease compared to HD and PD. Ere was no significant difference in median dialysis duration between HD and PD patients. Baseline laboratory values among the 3 groups were mostly normal, except for albumin, which was significantly lower in PD compared to HD (p < 0.00001) and dialysis initiation (p 0.0001) patients. There was no significant difference in probability of mortality in the HD versus dialysis initiation group (p 0.6300).
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