A retrospective cohort study predicting and validating impact of the COVID-19 pandemic in individuals with chronic kidney disease

Dashtban, Ashkan; Mizani, Mehrdad A.; Denaxas, Spiros; Nitsch, Dorothea; Quint, Jennifer; Corbett, Richard; Mamza, Jil B.; Morris, Tamsin; Mamas, Mamas; Lawlor, Deborah A.; Khunti, Kamlesh; Consortium, CVD-COVID-UK; Sudlow, Cathie; Hemingway, Harry; Banerjee, Amitava

Abstract

Chronic kidney disease (CKD) is associated with increased risk of baseline mortality and severe COVID-19, but analyses across CKD stages, and comorbidities are lacking. In prevalent and incident CKD, we investigated comorbidities, baseline risk, COVID-19 incidence, and predicted versus observed one-year excess death. In a national dataset (NHS Digital Trusted Research Environment [NHSD TRE]) for England encompassing 56 million individuals), we conducted a retrospective cohort study (March 2020 to March 2021) for prevalence of comorbidities by incident and prevalent CKD, SARS-CoV-2 infection and mortality. Baseline mortality risk, incidence and outcome of infection by comorbidities, controlling for age, sex and vaccination were assessed. Observed versus predicted one-year mortality at varying population infection rates and pandemic-related relative risks using our published model in pre-pandemic CKD cohorts (NHSD TRE and Clinical Practice Research Datalink [CPRD]) were compared. Among individuals with CKD (prevalent:1,934,585, incident:144,969), comorbidities were common (73.5% and 71.2% with one or more condition[s] in respective data sets, and 13.2% and 11.2% with three or more conditions, in prevalent and incident CKD), and associated with SARS-CoV-2 infection, particularly dialysis/transplantation (odds ratio 2.08, 95% confidence interval 2.04-2.13) and heart failure (1.73, 1.71-1.76), but not cancer (1.01, 1.01-1.04). One-year all-cause mortality varied by age, sex, multi-morbidity and CKD stage. Compared with 34,265 observed excess deaths, in the NHSD-TRE and CPRD databases respectively, we predicted 28,746 and 24,546 deaths (infection rates 10% and relative risks 3.0), and 23,754 and 20,283 deaths (observed infection rates 6.7% and relative risks 3.7). Thus, in this largest, national-level study, individuals with CKD have a high burden of comorbidities and multi-morbidity, and high risk of pre-pandemic and pandemic mortality. Hence, treatment of comorbidities, non-pharmaceutical measures, and vaccination are priorities for people with CKD and management of long-term conditions is important during and beyond the pandemic.

Citation

Dashtban, A., Mizani, M. A., Denaxas, S., Nitsch, D., Quint, J., Corbett, R., …Banerjee, A. (2022). A retrospective cohort study predicting and validating impact of the COVID-19 pandemic in individuals with chronic kidney disease. Kidney International, 102(3), 652-660. https://doi.org/10.1016/j.kint.2022.05.015

• Journal Article Type: Article
• Acceptance Date: May 9, 2022
• Online Publication Date: Jun 17, 2022
• Publication Date: 2022-09
• Publicly Available Date: May 30, 2023
• Journal: KIDNEY INTERNATIONAL
• Print ISSN: 0085-2538
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 102
• Issue: 3
• Pages: 652-660
• DOI: https://doi.org/10.1016/j.kint.2022.05.015
• Keywords: chronic kidney disease; mortality; SARS-CoV-2
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0085253822004483?via%3Dihub