#1175 Hypertension, diabetes, CKD and acute kidney disorder risk in COVID-19 patients

Abstract Background and Aims Chronic kidney disease (CKD), hypertension and diabetes were the risk factors for acute kidney disorder, but the association between these disease and incident acute kidney disorder in patients with COVID-19 is unclear. Method From the UK Biobank, 14,424 participants with COVID-19 (defined as SARS-CoV-2 test positive or hospitalized with COVID-19 diagnosis from 1 January 2020 and 26 August 2021) were studied. We firstly investigated the association between hypertension, diabetes and CKD at baseline and the risk of acute kidney disorders incidence using Cox proportional hazard regression adjusting age at the index date (continuous), Townsend deprivation index (3 categories by quantile), sex (female or male), smoking status (never, previous, current or unknown), BMI (thin: < 18.5 kg/m2, normal: 18.5 ≤ BMI < 25 kg/m2, overweight: 25 ≤ BMI < 30 kg/m2, obese: ≥ 30 kg/m2, unknown), education (college or university degree, A levels /AS levels /O levels /GCSEs / GSEs or equivalent, other degree, unknown), income (ultra-high, high, medium, low or unknown). We further categorized the disease conditions at baseline into four groups: COVID-19 patients with 0, 1, 2 or 3 out of diseases of hypertension, diabetes and CKD. Then, the association between different disease conditions at baseline and subsequent risk of incident acute kidney disorder was explored with multivariable Cox model. Subgroup analyses were performed according to sex. Results During the 28-day follow-up, 523 (3.63%) participants developed acute kidney disorder among 14,424 COVID-19 patients (aged at 66.62 ± 8.50 and 51.64% were female). CKD (HR: 3.20, 95% CI: 2.62-3.90, P < 0.001), hypertension (HR: 2.31, 95% CI: 1.86-2.86, P < 0.001) and diabetes (HR: 2.40, 95% CI: 1.98-2.92, P < 0.001) at baseline associated with increased risk of acute kidney disorder incidence. When considering coexisting disease conditions of hypertension, diabetes and CKD at baseline, COVID-19 patients with all the three conditions were at the highest risks for subsequent acute kidney disorder (HR: 8.81, 95% CI: 6.32-12.28, P < 0.001) as compared with COVID-19 patients without any of these conditions at baseline. The HRs for acute kidney disorder in COVID-19 patients with 2 or 1 disease conditions at baseline were 4.13 (95% CI: 3.14-5.44, P < 0.001) and 2.00 (95% CI: 1.56-2.58, P < 0.001), respectively. In subgroup analysis, we observed that both male and female COVID-19 patients with disease conditions at baseline significantly associated with increased risks of following acute kidney disorder incidence. HRs of male COVID-19 patients with 1 to 3 disease conditions at baseline were 1.82 (95% CI: 1.33-2.49, P < 0.001), 4.21 (95% CI: 3.01-5.88, P < 0.001) and 7.34 (95% CI: 4.82-11.20, P < 0.001), separately. The impact of disease conditions at baseline for subsequent risk of acute kidney disorder was much higher in female COVID-19 patients, the HRs were 2.34 (95% CI: 1.53-3.60, P < 0.001), 3.88 (95% CI: 2.37-6.33, P < 0.001) and 11.76 (95% CI: 6.83-20.27, P < 0.001) for 1 to 3 disease conditions at baseline respectively. Conclusion Hypertension, diabetes and CKD at baseline significantly associated with subsequent risk of acute kidney disorder incidence. COVID-19 patients with coexisting of these three conditions at baseline were at the highest risk for following acute kidney disorder, and the impact of disease conditions were much higher in female COVID-19 patients. This study provides evidence for prevention and management of acute kidney disorder in COVID-19 patients.