Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry

Uribarri, Aitor; Núñez-Gil, Iván J.; Aparisi, Alvaro; Becerra-Muñoz, Victor M.; Feltes, Gisela; Trabattoni, Daniela; Fernández-Rozas, Inmaculada; Viana-Llamas, María C.; Pepe, Martino; Cerrato, Enrico; Capel-Astrua, Thamar; Romero, Rodolfo; Castro-Mejía, Alex F.; El-Battrawy, Ibrahim; López-País, Javier; D’Ascenzo, Fabrizio; Fabregat-Andres, Oscar; Bardají, Alfredo; Raposeiras-Roubin, Sergio; Marín, Francisco; Fernández-Ortiz, Antonio; Macaya, Carlos; Estrada, Vicente

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite its international aggressive extension, with a significant morbidity and mortality, the impact of renal function on its prognosis is uncertain. METHODS: Analysis from the international HOPE-Registry (NCT04334291). The objective was to evaluate the association between kidney failure severity on admission with the mortality of patients with SARS-CoV-2 infection. Patients were categorized in 3 groups according to the estimated glomerular filtration rate on admission (eGFR > 60 mL/min/1.73 m(2), eGFR 30–60 mL/min/1.73 m(2) and eGFR < 30 mL/min/1.73 m(2)). RESULTS: 758 patients were included: mean age was 66 ± 18 years, and 58.6% of patient were male. Only 8.5% of patients had a history of chronic kidney disease (CKD); however, 30% of patients had kidney dysfunction upon admission (eGFR < 60 mL/min/1.73 m(2)). These patients received less frequently pharmacological treatment with hydroxychloroquine or antivirals and had a greater number of complications such as sepsis (11.9% vs 26.4% vs 40.8%, p < 0.001) and respiratory failure (35.4% vs 72.2% vs 62.0%, p < 0.001) as well as a higher in-hospital mortality rate (eGFR > 60 vs eGFR 30-60 vs and eGFR < 30, 18.4% vs 56.5% vs 65.5%, p < 0.001). In multivariate analysis: age, hypertension, renal function, 0(2) saturation < 92% and lactate dehydrogenase elevation on admission independently predicted all-cause mortality. CONCLUSIONS: Renal failure on admission in patients with SARS-CoV-2 infection is frequent and is associated with a greater number of complications and in-hospital mortality. Our data comes from a multicenter registry and therefore does not allow to have a precise mortality risk assessment. More studies are needed to confirm these findings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40620-020-00790-5) contains supplementary material, which is available to authorized users.