He Mingyue, Wang Yichen, Li Si, Gillespie Avrum
Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, United States.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Front Med (Lausanne). 2023 Nov 2;10:1250631. doi: 10.3389/fmed.2023.1250631. eCollection 2023.
Patients with advanced chronic kidney disease (CKD), end-stage kidney disease (ESKD), and kidney transplants (KT) are at an elevated risk for COVID-19 infection, hospitalization, and mortality. A comprehensive comparison of morbidity and mortality between these populations with kidney disease and individuals without any kidney disease is lacking.
We analysed the 2020 Nationwide Inpatient Sample (NIS) database for non-elective adult COVID-19 hospitalizations, categorizing patients into advanced CKD, ESKD, KT, and kidney disease-free cohorts. Our analysis included a description of the distribution of comorbidities across the entire spectrum of CKD, ESKD, and KT. Additionally, we investigated in-hospital mortality, morbidity, and resource utilization, adjusting for potential confounders through multivariable regression models.
The study included 1,018,915 adults hospitalized for COVID-19 in 2020. The incidence of advanced CKD, ESKD, and KT in this cohort was 5.8%, 3.8%, and 0.4%, respectively. Patients with advanced CKD, ESKD, and KT exhibited higher multimorbidity burdens, with 90.3%, 91.0%, and 75.2% of patients in each group having a Charlson comorbidity index (CCI) equal to or greater than 3. The all-cause in-hospital mortality ranged from 9.3% in kidney disease-free patients to 20.6% in advanced CKD, 19.4% in ESKD, and 12.4% in KT patients. After adjusting for potential confounders at both the patient and hospital levels, CKD stages 3-5; ESKD; and KT were found to be associated with increased odds of mortality, with adjusted odds ratios (aOR) of 1.34, 1.80, 2.66, 1.97, and 1.69, respectively.
Patients hospitalized for COVID-19 with advanced CKD, ESKD, or KT demonstrated a higher burden of comorbidities and increased mortality rates compared to those without kidney disease. After adjusting for confounders, CKD stages 3-5; ESKD; and KT were identified as independent risk factors for in-hospital mortality, illustrating a dose-response relationship between the odds of mortality and adverse outcomes as CKD progressed from stages 3 to 5. Our study highlights the necessity for enhanced management of comorbidities, targeted interventions, and vigorous vaccination efforts to mitigate the risk of adverse outcomes in the vulnerable populations of patients with CKD, ESKD, and KT.
晚期慢性肾脏病（CKD）、终末期肾病（ESKD）和肾移植（KT）患者感染新型冠状病毒肺炎（COVID-19）、住院及死亡风险升高。目前缺乏对这些肾病患者群体与无肾病个体之间发病率和死亡率的全面比较。
我们分析了2020年全国住院患者样本（NIS）数据库中成人非选择性COVID-19住院病例，将患者分为晚期CKD、ESKD、KT和无肾病队列。我们的分析包括描述CKD、ESKD和KT整个范围内合并症的分布情况。此外，我们调查了住院死亡率、发病率和资源利用情况，并通过多变量回归模型对潜在混杂因素进行了调整。
该研究纳入了2020年因COVID-19住院的1,018,915名成人。该队列中晚期CKD、ESKD和KT的发病率分别为5.8%、3.8%和0.4%。晚期CKD、ESKD和KT患者的合并症负担更高，每组中Charlson合并症指数（CCI）等于或大于3的患者分别为90.3%、91.0%和75.2%。全因住院死亡率从无肾病患者的9.3%到晚期CKD患者的20.6%、ESKD患者的19.4%和KT患者的12.4%不等。在对患者和医院层面的潜在混杂因素进行调整后，发现CKD 3-5期、ESKD和KT与死亡几率增加相关，调整后的优势比（aOR）分别为1.34、1.80、2.66、1.97和1.69。
与无肾病患者相比，因COVID-19住院的晚期CKD、ESKD或KT患者合并症负担更高，死亡率更高。在对混杂因素进行调整后，CKD 3-5期、ESKD和KT被确定为住院死亡率的独立危险因素，这表明随着CKD从3期进展到5期，死亡几率与不良结局之间存在剂量反应关系。我们的研究强调了加强合并症管理、针对性干预和积极疫苗接种工作的必要性，以降低CKD、ESKD和KT患者这一脆弱人群中不良结局的风险。
