Icu admission during the COVID-19 pandemic in overwhelmed institutions: Is CKD a significant risk factor for consideration in icu admission

Background: The SARS-CoV-2 pandemic has strained healthcare systems worldwide. Increasing age and comorbidities, as CKD are associated with worse outcomes. Information is needed to assist the decision-making process for ICU admission. The aim of this study was to evaluate mortality rates of COVID-19 CKD patients, percentage of patients admitted to ICU and the role of CKD as a risk factor (RF) for mortality. Methods: Prospective cohort study from a referral center for COVID-19 in Mexico City. All patients hospitalized between March 2020 and March 2021 with complete follow up were included. Subjects were segregated into 4 groups: 1) CKD stages 3-4 (CKD3-4, n=109), 2) renal replacement therapy (RRT, n=103), 3) kidney transplant (KT, n=31), and 4) patients without CKD (no CKD, n=2520). We registered if ICU admission was requested and if patients were admitted or rejected. RF associated with mortality were evaluated by Cox-regression analysis. Results: Mean age of the population was 56 years (IQR 46-67), 1697 (61%) were male, 837 (30%) had diabetes, and 1105 (40%) were obese. The group of CKD3-4 patients was older (median 62 years, IQR 38-86), diabetic (58%), and had higher incidence of acute kidney injury (76%). ICU admission was requested for 52 (48%), 32 (31%), 10 (32%), and 1043 (41%) patients in the CKD3-4, RRT, KT, and no CKD groups, respectively (p<0.001). Of these, 17/52 (33%), 12/32 (38%), 4/10 (40%), and 576/1043 (55%) were admitted (p<0.001). Mortality in each group and in patients admitted in ICU is shown in Figure 1. The adjusted multivariate analysis for mortality showed that CKD was not associated with increased mortality. Conclusions: CKD patients during the COVID-19 pandemic, conditioning high mortality rates. However, adjusted analysis suggests that CKD should not be considered as a single criterion for the decision of admission to ICU.