Outcomes of Patients with CKD and ESRD Hospitalized with COVID-19: A Retrospective Cohort Study in Michigan

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Background: A large patient cohort, multivariate regression models, and inverse probability of treatment weights (IPTWs) to determine the effect of kidney disease on mortality in hospitalized CoVID-19 patients. Methods: 6,737 hospitalized, SARS-CoV-2 positive patients from the South East Michigan CoVID Consortium dataset were analyzed for common dimensions of risk factors for increased mortality. Univariate, multivariate logistic regression, and IPTW propensity scoring models were used to reflect the effect of each variable on outcomes. IPTW models required patient population trimming to include patients only within the region of common support, thus less patients were analyzed in the fully adjusted (N=6,117) and IPTW (N=4131) models. Results: Unadjusted models show significant increases in all outcomes in any level of renal disease. No association with increased mortality as a result of renal disease after adjusting for covariates. IPTW model finds that renal dysfunction infers longer duration of hospitalization, and average higher SOFA scores. In CKD patients, SOFA scores were 1.34 times higher (p<0.001) versus control patients. ESRD patients were hospitalized longer (IRR=1.19;p<0.001), and had higher SOFA scores (IRR=1.98;p<0.001) than control patients. Conclusions: Here, we show that renal disease in of itself does not directly lead to increased mortality in CoVID-19 patients. Initial findings of increased mortality in CKD and ESRD patients may more likely be a result of chronic disease burden as shown by sequela comorbidities seen in CKD and ESRD patients. - Association between CKD/ESRD and Binary CoVID-19 Outcomes Model N Overall p-value CKD vs Control ESRD vs Control ESRD vs CKD RR (95% CI) p-value RR (95% CI) p-value RR (95% CI) p-value In-Hospital Death Unadjusted 6737 <0.001 1.72 (1.45-2.05) <0.001 1.43 (1.02-2.00) 0.038 0.83 (0.57-1.19) 0.32 IPTW 4131 0.59 1.06 (0.85-1.33) 0.61 0.79 (0.44-1.42) 0.44 0.75 (0.4-1.39) 0.35 In-Hospital Death or Expected Death (Transfer to Hospice) Unadjusted 6737 <0.001 1.76 (1.52-2.03) <0.001 1.23 (0.9-1.68) 0.19 0.70 (0.50-0.98) 0.036 IPTW 4131 0.95 1.01 (0.84-1.23) 0.90 0.92 (0.52-1.66) 0.79 0.92 (0.5-1.67) 0.77 Admission to ICU Unadjusted 6737 <0.001 1.31 (1.15-1.49) <0.001 (1.88 (1.58-2.25) <0.001 1.43 (1.16-1.75) 0.001 IPTW 4131 0.42 1.90 (0.76-1.07) 0.25 1.10 (0.78-1.54) 0.59 1.22 (0.83-1.75) 0.31 Total Duration of Hospitalization (days) Unadjusted 6737 <0.001 1.22 (1.15-1.29) <0.001 1.53 (1.39-1.70) <0.001 1.27 (1.12-1.41) <0.001 IPTW 4131 <0.001 1.03 (0.98-1.08) 0.28 1.19 (1.12-1.27) <0.001 1.16 (1.08-1.25) <0.001 Highest SOFA score recorded across inpatient stay Unadjusted 5842 <0.001 1.65 (1.52-1.79) <0.001 2.53 (2.20-2.91) <0.001 1.54 (1.32-1.79) <0.001 IPTW 3682 <0.001 1.34 (1.25-1.44) <0.001 1.98 (1.80-2.18) <0.001 1.47 (1.33-1.64) <0.001

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