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SAN DIEGO -- Certain factors were highly predictive of severe COVID illness in hospitalized patients who had 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, having hyperglycemia upon admission was tied with more than a 10 times higher risk of severe COVID illness (OR 10.49, 95% CI 3.09-35.60), according to Ella Burguera-Couce, an MD candidate at the Warren Alpert Medical School of Brown University in Providence, Rhode Island.

Also, patients with stage 5 CKD, or were on dialysis at the time of hospitalization, had over four times higher risk for a severe course of COVID illness (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 suggests that the combination of progressive CKD and T2D amplifies their individual impacts by magnitudes," she said.

These associations were controlled for age, gender, race/ethnicity, obesity status, hypertension, pulmonary disease, and cardiovascular disease. Severe illness was defined as a composite outcome of ICU admission, 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 the cohort was white, while another 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 had GFR data. A little more than half had early-stage CKD, while 18.8% had stage 3b disease, 16.3% had stage 4, and 14.4% had stage 5. Among this group of hospitalized patients, 88% had pre-exiting hypertension upon admission. Pre-existing obesity (50%) and pulmonary disease (38%) were also both common comorbidities.

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

These patients with end-stage kidney disease had the longest hospital durations of all the CKD categories, averaging a 15-day stay. Those with stage 3b CKD (GFR 30-44 mL/min) and stage 4 CKD (GFR 15-29 mL/min) both averaged around a 10-day hospital stay. Patients with a normal GFR or early-stage 1/2/3a CKD (GFR ≥45 mL/min) averaged around an 8-day hospital stay for COVID.

While common across the board, hyperglycemia was most common among stage 5 CKD patients:

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

Following a similar pattern, only 5% of patients with stage 1/2/3a CKD required mechanical ventilation during their hospital stay versus 7%, 18%, and 29% of those with stage 3b, stage 4, or stage 5 CKD, respectively. Admission to the ICU for COVID also steadily increased among patients at higher CKD levels: 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 the hospital from COVID, this rose to 11%, 21, and 29% of stage 3b, stage 4, and stage 5 patients, respectively.

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

Burguera-Couce said she and her colleagues plan to look at data regarding diabetes medication.

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