UC Davis

Abstract

Since December of 2019, infection with SARS-CoV-2, the virus that causes COVID-19, has led to the most serious infectious disease pandemic since the influenza pandemic of 1918-1920. In the United States, over 49.2 million cases of COVID-19 were diagnosed from February 2020 to December 6, 2021, resulting in 788,315 deaths. In the state of California, over 5.1 million cases of COVID-19 were diagnosed in the same time period, resulting in 75,102 deaths and 3,562 individuals presently hospitalized. While the majority of individuals affected by COVID-19 exhibit only mild symptoms that do not require hospitalization, many require hospitalization, with the most ill patients needing intensive care unit admission, mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) treatment.

End stage renal disease (ESRD) is caused when nephrons in the kidneys are damaged over time, the kidneys lose their ability to remove impurities in the blood, and kidney dialysis is required on a regular basis. Infection is the second most reported cause of death in the ESRD population. Annual death rates from pneumonia and sepsis are substantially higher among ESRD patients than among the general population. ESRD patients have a compromised and poorly regulated immune system, which may increase susceptibility to bacterial and viral infections, including the SARS-COV-2 virus. Research studies of ESRD patients who are hospitalized with Covid-19 are needed so that these patients can be risk stratified to appropriate therapeutic treatment regimens and receive the best possible in-hospital care.

A retrospective cohort study was conducted to explore 6 clinical outcomes for individuals with and without ESRD, hospitalized with Covid-19 at one of the 5 tertiary care, academic hospitals of the University of California (UC Davis, UC Irvine, UC Los Angeles, UC San Diego, and UC San Francisco). The University of California COVID Research Database (UC CORDS), a large, harmonized database provided by the UC Health Data Warehouse (UCHDW), was utilized for this purpose. In Chapter 1, logistic regression analysis was used to investigate the risks for in-hospital death and hospital length of stay of 7 days or longer. In Chapter 2, the risks of ICU admission and ICU length of stay of 7 days or longer were also explored using logistic regression analysis. In Chapter 3, Cox proportional hazards regression analysis was used to investigate the risks for death and readmission within 30 days post-hospitalization for COVID-19. Factors associated with each of the above clinical outcomes were also explored in separate analyses.