AUTHOR=He Mingyue , Wang Yichen , Li Si , Gillespie Avrum 

TITLE=Nationwide in-hospital mortality and morbidity analysis of COVID-19 in advanced chronic kidney disease, dialysis and kidney transplant recipients

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1250631

DOI=10.3389/fmed.2023.1250631

ISSN=2296-858X

ABSTRACT=Background: 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. NonethelesA comprehensive comparison of morbidity and mortality between these groups populations with kidney disease and individuals without CKD any kidney disease is lacking. Methods: We analysed the 2020 Nationwide Inpatient Sample (NIS) database for non-elective adult COVID-19 hospitalizations, categorizing patients into advanced CKD, ESKD, KT, and CKDkidney 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.We investigated in-hospital mortality, morbidity, and resource utilization, adjusting for potential confounders through multivariable logistic or linear 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, 4, 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. The all-cause in-hospital mortality ranged from 9.7% in CKD-free patients to 20.5% in advanced CKD, 19.7% in ESKD, and 12.4% in KT patients. ESKD patients exhibited higher comorbidity burdens, with adjusted outcomes showing increased mortality (aOR 1.