BMC Infectious Diseases (May 2024)

Prognostic significance of chronic kidney disease and impaired renal function in Japanese patients with COVID-19

  • Hiromu Tanaka,
  • Shotaro Chubachi,
  • Takanori Asakura,
  • Ho Namkoong,
  • Shuhei Azekawa,
  • Shiro Otake,
  • Kensuke Nakagawara,
  • Takahiro Fukushima,
  • Ho Lee,
  • Mayuko Watase,
  • Kaori Sakurai,
  • Tatsuya Kusumoto,
  • Katsunori Masaki,
  • Hirofumi Kamata,
  • Makoto Ishii,
  • Naoki Hasegawa,
  • Yukinori Okada,
  • Ryuji Koike,
  • Yuko Kitagawa,
  • Akinori Kimura,
  • Seiya Imoto,
  • Satoru Miyano,
  • Seishi Ogawa,
  • Takanori Kanai,
  • Koichi Fukunaga

DOI
https://doi.org/10.1186/s12879-024-09414-w
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 10

Abstract

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Abstract Background Renal impairment is a predictor of coronavirus disease (COVID-19) severity. No studies have compared COVID-19 outcomes in patients with chronic kidney disease (CKD) and patients with impaired renal function without a prior diagnosis of CKD. This study aimed to identify the impact of pre-existing impaired renal function without CKD on COVID-19 outcomes. Methods This retrospective study included 3,637 patients with COVID-19 classified into three groups by CKD history and estimated glomerular filtration rate (eGFR) on referral: Group 1 (n = 2,460), normal renal function without a CKD history; Group 2 (n = 905), impaired renal function without a CKD history; and Group 3 (n = 272), history of CKD. We compared the clinical characteristics of these groups and assessed the effect of CKD and impaired renal function on critical outcomes (requirement for respiratory support with high-flow oxygen devices, invasive mechanical ventilation, or extracorporeal membrane oxygen, and death during hospitalization) using multivariable logistic regression. Results The prevalence of comorbidities (hypertension, diabetes, and cardiovascular disease) and incidence of inflammatory responses (white blood counts, and C-reactive protein, procalcitonin, and D-dimer levels) and complications (bacterial infection and heart failure) were higher in Groups 2 and 3 than that in Group 1. The incidence of critical outcomes was 10.8%, 17.7%, and 26.8% in Groups 1, 2, and 3, respectively. The mortality rate and the rate of requiring IMV support was lowest in Group 1 and highest in Group 3. Compared with Group 1, the risk of critical outcomes was higher in Group 2 (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.03–1.70, P = 0.030) and Group 3 (aOR: 1.94, 95% CI: 1.36–2.78, P < 0.001). Additionally, the eGFR was significantly associated with critical outcomes in Groups 2 (odds ratio [OR]: 2.89, 95% CI: 1.64–4.98, P < 0.001) and 3 (OR: 1.87, 95% CI: 1.08–3.23, P = 0.025) only. Conclusions Clinicians should consider pre-existing CKD and impaired renal function at the time of COVID-19 diagnosis for the management of COVID-19.

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