COVID-19 Among Hospitalized Patients with Kidney Disease: Experience at a US Midwestern Academic Medical Center

Objective: We sought to characterize the clinical profiles and outcomes of patients with coronavirus disease 2019 and comorbid kidney disease hospitalized at a U.S. urban, Midwestern tertiary care hospital. Methods: In this single-center observational study, we describe 205 patients with acute kidney injury (n = 98), dialysisdependent chronic kidney disease stage 5 (n = 54), or kidney transplant (n = 53), admitted during the first surge of the local pandemic, from March 19, 2020, to July 31, 2021. Results: Most patients in the cohort were African American (acute kidney injury, 51%; dialysis-dependent chronic kidney disease stage 5, 82%; kidney transplant, 62%), and obesity was common (acute kidney injury, 53%; dialysis-dependent chronic kidney disease stage 5, 44%; kidney transplant, 59%). Mechanical ventilation was required in 50% of the acute kidney injury, 22% of the dialysis-dependent chronic kidney disease stage 5, and 13% of the kidney transplant recipients. Nearly half of the acute kidney injury patients (46%) died and 49% required kidney replacement therapy, while in-hospital mortality was 24% in the dialysis-dependent chronic kidney disease stage 5 patients and 9% in the kidney transplant recipients. Logistic regression analysis identified older age and patient group as leading correlates of mortality, with lower death risk in kidney transplant (24%; odds ratio (OR), 0.17; 95% CI 0.06-0.47) and dialysis-dependent chronic kidney disease stage 5 (9%; OR, 0.36; 95% CI 0.16-0.78) patients compared to acute kidney injury patients (46%). Obesity was associated with a 5-fold increased mortality risk in the coronavirus disease 2019 patients with acute kidney injury (OR, 5.32; 95% CI 1.41-20.03) but not in dialysis-dependent chronic kidney disease stage 5 or kidney transplant patients. Conclusions: During the first surge of the pandemic, kidney patients hospitalized with coronavirus disease 2019 experienced high mortality, especially those with acute kidney injury, older age, and obesity. Identifying those at the highest risk for adverse outcomes may direct preventative strategies including counseling on vaccination. Keywords: Acute kidney injury, coronavirus disease-2019, COVID-19, dialysis, mortality, obesity, outcomes, transplant