The Impact of COVID-19 on Patients with Chronic Kidney Disease and Predictive Factors for Disease Mortality

Objective: We aimed to describe clinical characteristics and course of chronic kidney disease patients with COVID-19 and to identify determinants of in-hospital mortality. Methods: Seventy-one chronic kidney disease patients with COVID-19 were enrolled. The primary endpoint was death from all causes discussed in this article. The relationship between mortality and demographic, clinical, and laboratory data were examined. Results: Of 71 patients, 29 (40.8%) died. Dead were older, were more likely to have low critical oxygen saturation (SpO(2)) and deterioration of renal function, and exhibited less favorable laboratory features, including higher neutrophils, neutrophil to lymphocyte ratio, and systemic immune-inflammation index, as well as a lower lymphocyte. Acute kidney injury rate was high (71.8%) and 23.5% needed dialysis. Disease outcome did not differ across baseline chronic kidney disease stages. Systemic immune-inflammation index had a higher prediction accuracy for in-hospital mortality (AUC = 0.732). Patients in the high systemic immune-inflammation index group were older, had higher peak Cr, higher rate of acute kidney injury (85.3% vs. 59.5%), severe disease (79.4% vs. 35.1%), and mortality (64.7% vs. 18.9%) compared to those in low systemic immune-inflammation index group. Older age (>72 years), SpO(2) <= 90%, high systemic immune-inflammation index, and severe acute kidney injury requiring dialysis were predictors of in-hospital mortality. Conclusion: Chronic kidney disease patients with COVID-19 had a high mortality rate associated with older age, acute kidney injury requiring dialysis, higher systemic immune-inflammation index, and lower SpO(2) . Systemic immune-inflammation index at admission may be used for early identification of those at risk. Interventions for optimal oxygenation, early attenuation of the inflammatory response, and prevention of acute kidney injury may improve the prognosis of chronic kidney disease patients with COVID-19.