THE IMPACT OF THE KIDNEY FUNCTION ON THE PROGRESSION AND OUTCOMES OF CORONAVIRUS TREATMENT

Abstract

Introduction. Manifestations of kidney damage in coronavirus disease vary from asymptomatic proteinuria to acute kidney damage that requires renal replacement therapy. Decreased glomerular filtration rate (GFR) is associated with worse prognosis and increased in-hospital mortality. Aim. To compare the clinical and laboratory characteristics of the course and the results of the coronavirus disease treatment in hospitalized patients depending on the GFR. Materials and methods. The study included 243 hospitalized patients with moderate and severe coronavirus disease aged from 18 to 88 years, among them 110 females and 133 males. All patients were segregated into two groups depending on GFR: 1st group – 132 individuals with GFR > 60 mL/min per 1.73m2, 2nd group – 111 individuals with GFR <60 mL/min per 1.73m2. A general clinical examination and laboratory tests (PCR for the detection of SARS-CoV-2 virus, general blood test, glucose, liver and kidney markers, coagulation tests, d-dimer, interleukin-6, ferritin, procalcitonin, and determination of albumin and creatinine in urine with calculation of their ratio), instrumental studies (computed tomography or multi-positional radiography of the thoracic organs, pulse oximetry) were performed. The CKD-EPI (2021 update) formula was used to calculate GFR. Comparison of groups was performed by means of the Mann-Whitney U-test. Categorical data were presented as proportions and analyzed using the Chi-square test. The results were considered statistically reliable at p<0.05. Results. Among the cohort of patients with diminished GFR, there was a notable prevalence of symptoms such as hemoptysis, hematuria, hypertension, and pronounced weakness. Additionally, higher levels of serum CRP, interleukin-6, and procalcitonin were significantly more frequent in this group. It was found that 7 patients (5.3%) among the patients of the 1st group died, while 22 patients (19.8%) died in the 2nd group, p=0.0005. Conclusions. In patients with reduced GFR, such symptoms as hemoptysis, hematuria, hypertension and severe general weakness were significantly more often observed. Laboratory indicators included higher levels of CRP, interleukin-6, procalcitonin, and albumin/creatinine ratio, which indicated a more severe course and activity of the inflammatory process. The mortality rate in patients with reduced GFR was 19.8% and was significantly higher than in the group with normal GFR – 5.3%, p=0.0005.