POS-894 PREDICTING PANDEMIC-RELATED EXCESS-DEATH USING PRE-PANDEMIC RISK OF MORTALITY IN INDIVIDUALS WITH CHRONIC KIDNEY DISEASE

Abstract

Chronic Kidney Disease (CKD) is a global burden on public health, both as a risk factor for mortality, and as the end syndrome of underlying diseases. CKD is a common comorbidity associated with increased risk of severe coronavirus infection and poor clinical outcomes. The pandemic has had both direct (through infection) and indirect impact. The direct impact on individuals with CKD and other underlying conditions is related to baseline risk, influenced by age, multimorbidity and other socio-demographic factors. However, previous studies of COVID-19 in CKD have been small scale (12-1099 cases), mostly focused on end-stage CKD, and ignored major comorbidities. Thus, using large-scale, population-based electronic health records, in people with incident CKD we aimed to (a) identify the most common comorbidities; (b) estimate 1-year (pre-pandemic) risk of mortality and (c) predict excess deaths related to COVID-19 over 1-year of pandemic based on pre-pandemic risk of mortality at different population infection rates and relative risks. We used linked primary and secondary care records (Clinical Practice Research Datalink GOLD data) from England; of 3,862,012 individuals aged ≥ 30 registered with a GP practice between 1997 and 2017. Incident CKD was identified based on diagnosis codes and eGFR levels; classified mutually exclusively into five CKD Stages. The underlying conditions were obtained using validated phenotyping algorithms in CALIBER and the most prevalent ones were identified. The 1-year mortality were estimated using Kaplan–Meier survival analysis; stratified by key demographic factors and number of comorbidities. Using these pre-pandemic risk estimates and our recently published Lancet model, we calculated excess COVID-19 related deaths at different population infection rates and relative risks. For validation, we identified the number of people who died with both CKD and positive COVID-19 test result during 1-year of pandemic using the contemporary NHSD TRE data of England (NHS Digital Trusted Research Environment, n=54 million). We identified 294,381 individuals with incident CKD (mean age 72.5 years; female: 59%). Multimorbidity was common among CKD patients especially the presence of hypertension (61.4%) and CVD complications (35.6%) (Fig 1 ). The proportion of CKD patients having at least one underlying condition increases significantly either by age or CKD stage whilst age was the main confounder within each CKD stage. Age, Stage of CKD and underlying conditions combined to influence pre-pandemic risk (Fig 2 ). At an IR of 10%, we predicted 31003 and 46505 excess deaths at RR of 2 and 3 respectively (Table 1 ) which is close to actual observed mortality (47214) from the NHSD TREin England. View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) Individuals with CKD have high risk of pre-pandemic mortality particularly those with comorbidities. The data on multimorbidity, CKD stage and age together could help prioritise patients for vaccination, post-COVID policy, and designing stratified pathways for CKD patients. We illustrate that the direct burden of pandemic could be predicted using pre-pandemic large scale EHR data.