An analysis of Geisinger's electronic health records has revealed chronic kidney disease to be the leading risk factor for hospitalization from COVID-19.

A team of Geisinger researchers studied the health records of 12,971 individuals who were tested for COVID-19 within the Geisinger system between March 7 and May 19. Of this group, 1,604 were COVID-positive and 354 required hospitalization. The team analyzed the records for association between specific clinical conditions, including kidney, cardiovascular, respiratory and metabolic conditions, and COVID-19 hospitalization.

Overall, chronic kidney disease was most strongly associated with hospitalization, and COVID-19 patients with end-stage renal disease were 11 times more likely to be admitted to the hospital than patients without kidney disease.

The results were published in PLOS ONE.

"Previous studies have identified a variety of health conditions associated with an increased risk of COVID-related hospitalization, including diabetes, heart failure, hypertension, and chronic kidney disease. What is significant here is the magnitude of the kidney disease-related risk," said Alex Chang, M.D., Geisinger nephrologist and co-director of Geisinger's Kidney Health Research Institute. "These findings highlight the need to prevent COVID-19-related illness in patients with kidney disease and other high-risk conditions."

How underlying medical conditions increase the risk of COVID-19-related complications is not yet fully clear; however, the study suggests that the physiological stress caused by an excessive inflammatory response to COVID-19 infection could destabilize organs already weakened by chronic disease, or that organ injury from the virus could act as a 'second-hit' to these organs.

"Consistent with this hypothesis, kidney and heart are among the tissues with the highest expression of ACE2, a SARS-CoV-2 receptor," the team wrote.

While the sample size studied was relatively small, Geisinger's resources as an integrated health system allowed for a fairly comprehensive analysis of available data.

"Our team used a novel approach made possible by our extensive electronic health records, unique demographic data and integrated health system," said Tooraj Mirshahi, Ph.D., associate professor for Geisinger's Department of Molecular and Functional Genomics. "We were able to perform this study despite having a much lower number of COVID-19 cases compared to large hospitals in metropolitan areas."

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