Patients with chronic kidney disease have a poorer prognosis of coronavirus disease 2019 (COVID-19): an experience in New York City - International Urology and Nephrology

We analyzed Mount Sinai Health System (MSHS) medical records up to March 29, 2020, using Epic SlicerDicer software. We extracted data from patients who had positive results for the COVID-19 reverse-transcription polymerase chain reaction (RT-PCR) test. The 10th revision of the International Statistical Classification of Diseases code system was used to identify medical conditions. p values were calculated by using a 2-tailed χ² test, risk ratio (RR), and odds ratios (OR) were calculated with 95% confidence intervals (CI). MSHS waived institutional review board approval since this research used only deidentified, aggregate-level data. 3391 patients were positive for the COVID-19 RT-PCR test during the study period, with 210 (6.2%) CKD patients among them. The proportion of elderly patients was significantly higher in patients with CKD. Without adjusting age groups, patients with CKD had a higher risk of mortality and intubation (RR [95%CI]; 2.51 [1.82–3.47], p < 0.001 and 2.05 [1.40–3.01], p < 0.001, respectively). By stratifying the patients by age groups, we detected a significantly increased risk of mortality in patients age from 60 to 79 (1.80 [1.15–2.83]), but not in patients age 80 or older (1.15 [0.71–1.86]). In patients with CKD, we found a significantly higher rate of death in patients with atrial fibrillation (Afib) (OR [95%CI]; 2.13 [1.03–4.43]), heart failure (HF) (2.09 [1.16–3.77]), and ischemic heart disease (IHD) (2.87 [1.04–3.36]) (Table 1). Our study showed that CKD patients may have a higher risk of intubation and death. This tendency was consistent for each age group. A possible explanation of these findings is a proinflammatory state: patients with kidney dysfunction have deficits in immune cell populations [4], which may lead to increased lung inflammation.

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Authors and Affiliations

1. Department of Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA

   Takayuki Yamada, Takahisa Mikami, Nitin Chopra, Hirotaka Miyashita, Svetlana Chernyavsky & Satoshi Miyashita

Contributions

TY had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TY, HM. Acquisition, analysis, or interpretation of data: TY, TM. Drafting of the manuscript: TY, NC. Critical revision of the manuscript for important intellectual content: TY, HM, TM, SM, NC, SC. Statistical analysis: TY, TM, SM. Administrative, technical, or material support: TY, NC. Study supervision: SM, SC.

Corresponding author

Correspondence to Takayuki Yamada.

Conflict of interest

TY reports no conflict of interest. TM reports no conflict of interest. NC reports no conflict of interest. HM reports no conflict of interest. SC repots no conflict of interest. SM reports no conflict of interest.

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