The role of CKD on incidence and morbidity of COVID-19: A one-year review in us veterans

Background: The Coronavirus disease 2019 (COVID-19) pandemic has greatly impacted the global community. With approximately 15% of the United States (US) population having chronic kidney disease (CKD), it is important to understand how COVID-19 interacts with CKD. Methods: We used the VA COVID-19 resource data to examine the role of CKD on incidence and morbidity of COVID-19. The database combines standard hospital data, administrative and clinical record search results. CKD is defined in this system as having occurred at any time in the 2 years prior to the COVID-19 test, while new results (incidence) refer to 60 day period after positive test. Patients with chronic kidney failure (CKF2yrs) were excluded. We examined the effect of basic demographics and common risk factors on all-cause mortality, ICU admissions, ventilator use, and dialysis. Statistical analysis (SAS enterprise guide 7.1) used frequency distributions (chi square). The data was limited to the first year of collection. Results: The population consisted of 1,305,466 veterans. Of these, 235,857 tested positive (18.1%) and 140,143 (11.4%) had CKD. White, male patients aged over 60 years predominated (60.7%, 81.2%, 53.3%). These demographics had no significant effect on COVID-19 incidence. Hypertension (HTN), diabetes mellitus type 2 (DM2), and smoking were taken as risk factors. These were found to have little effect (OR 0.86 -1.22) while BMI had more weight (1.41). In the positive population CKD was recorded in 28,420 (12%). In these patients, significant differences were associated with CKD, such as higher death rate (OR 4.05), ICU admission and ventilator use when compared to the total population (OR 1.24, 2.88 vs 1.25, 3.13). Need for acute dialysis was disproportionately greater(OR 36.75). Conclusions: CKD had no effect on incidence of COVID-19. Once present it was associated with higher rates of ICU admission, ventilator use, need for dialysis and allcause mortality. This calls for increased vigilance in our patients with CKD to prevent COVID-19 infection.