Patients with type 2 diabetes and CKD face poor COVID outcomes

SAN DIEGO — Certain factors were highly predictive of severe COVID disease in hospitalized patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), a researcher reported.

In a single-center study of patients with T2D and CKD hospitalized with COVID-19 infection, hyperglycemia on admission was associated with a more than 10-fold greater risk of severe COVID-19 (OR 10.49 , 95% CI 3.09-35.60). to Ella Burguera-Couce, MD candidate at Brown University’s Warren Alpert Medical School in Providence, Rhode Island.

Patients with stage 5 CKD or those on dialysis at the time of hospitalization were also more than four times more likely to develop severe COVID-19 disease (OR 4.67, 95% CI 2.25-9.71), she reported in a presentation at the American Association of Clinical Endocrinology (AACE) Annual Meeting.

“Our data suggest that combining progressive CKD and T2D amplifies their individual effects by orders of magnitude,” she said.

These associations were controlled for age, sex, race/ethnicity, obesity status, hypertension, pulmonary disease, and cardiovascular disease. Severe illness was defined as the composite outcome of ICU admission, the need for mechanical ventilation, and in-hospital mortality.

Data on patients with COVID came from the LifeSpan Health System in Rhode Island. More than half of the cohort was white, while an additional 23% were Hispanic/Latino and 2% were Black. Most had commercial health insurance (46%), followed by Medicare (30%), Neighborhood Health Plan of Rhode Island (18%), Medicaid (4%), and self-pay (2%).

The authors found 3,852 patients admitted with COVID infection, of whom 1,254 had T2D and 1,122 GFR data. Just over half had early-stage CKD, while 18.8% had stage 3b disease, 16.3% had stage 4, and 14.4% had stage 5. In this group of hospitalized patients, 88% had pre-existing hypertension at admission. Pre-existing obesity (50%) and lung disease (38%) were also common comorbidities.

The authors reported that patients with stage 5 CKD (GFR < 15 mL/min) had significantly higher overall odds of ICU admission, mechanical ventilation, mortality, and a length of stay of 1 week or longer.

These patients with end-stage renal disease had the longest hospital stay of any CKD category, with a median stay of 15 days. Those with stage 3b CKD (GFR 30–44 mL/min) and stage 4 CKD (GFR 15–29 mL/min) both had a median hospital stay of about 10 days. Patients with normal GFR or early-stage 1/2/3a CKD (GFR ≥ 45 mL/min) had a median hospitalization of approximately 8 days for COVID.

Hyperglycemia was common but most common in stage 5 CKD patients:

  • Level 5: 66%
  • Level 4: 54%
  • Level 3: 55%
  • Level 1/2/3a: 45%

Following a similar pattern, only 5% of patients with stage 1/2/3a CKD required mechanical ventilation during their hospitalization compared to 7%, 18%, and 29% of patients with stage 3b, stage 4, or stage 5 CKD, respectively . ICU admissions for COVID also increased steadily in patients with higher CKD scores: 11% (Stage 1/2/3a), 17% (Stage 3B), 25% (Stage 4), and 34% (Stage 5) .

While only 4% of early-stage CKD patients died in hospital from COVID, that number rose to 11%, 21, and 29% of stage 3b, stage 4, and stage 5 patients, respectively.

Another independent risk factor for severe COVID-19 was hospitalization during the first wave of the pandemic (OR 2.22, 95% CI 1.02-4.83) between March 1 and June 30, 2022 compared to the second (July 1, 2020 – March 2, 28, 2021) and third wave (March 1, 2021 to present).

Burguera-Couce said she and her colleagues plan to look at data on diabetes medications.

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    Kristen Monaco is a staff writer focused on endocrinology, psychiatry and nephrology news. She is based out of the New York office and has been with the company since 2015.

disclosure

Burguera-Couce disclosed no industry ties.

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