Predictors of In-hospital Mortality Among COVID-19-infected Chronic Kidney Disease Patients on Maintenance Hemodialysis: A Retrospective Cohort Study

 Patients with chronic kidney disease (CKD) on maintenance hemodialysis are highly vulnerable to coronavirus disease 2019 (COVID-19) infection and poorer outcomes and mortality.

 The study aimed at identifying the various clinical and biochemical predictors of in-hospital mortality in this particular group of patients.

 In this retrospective cohort study, the baseline demographic, clinical, and laboratory data were collected from patients with preexisting CKD on maintenance hemodialysis and with COVID-19 infection. The statistical analysis of the collected data was performed using SPSS version 24 (SPSS Inc, Chicago, IL, USA).

 The data obtained from 35 patients from the first wave of the pandemic were analyzed. The mortality rate was 23% (8 patients). Analyzing the comparison between survivors and non-survivors revealed that the older age (49 [IQR, 42 – 55] years vs. 70 [IQR, 54 – 74] years, P = 0.016), severe disease at presentation (15% vs. 75%, P = 0.004), and need for invasive mechanical ventilation (0% vs. 75%, P = 0.001) were the factors significantly associated with in-hospital mortality. Among baseline biochemical markers, severe lymphocytopenia (11 [IQR, 7 – 16] vs. 4.2 [IQR, 3 – 8], P = 0.011), high serum glutamic oxaloacetic transaminase (23 [IQR, 15.6 – 48] vs. 80 [IQR, 60- 105], P = 0.001), blood urea (71 [IQR, 28 - 120) vs. 160 (IQR, 142 - 355), P = 0.002) and higher value of inflammatory markers, interleukin-6 (IL-6), and procalcitonin, as well as fibrinogen and low baseline albumin, were also significantly associated with in-hospital mortality.

 The older age, severe disease at presentation, need for invasive mechanical ventilation, raised baseline IL-6, procalcitonin, serum glutamic oxaloacetic transaminase, blood urea, and lower level of albumin may have been valuable predictors of in-hospital mortality and poor outcomes in patients with COVID-19-infected chronic kidney disease on maintenance hemodialysis.