POS-628 THE IMPACT OF OBESITY ON ADVERSE OUTCOME OF COVID-19 IN PATIENTS ON MAINTENANCE HEMODIALYSIS DUE TO DIABETIC KIDNEY DISEASE

      Introduction

      Patients on maintenance hemodialysis (MHD) are at a high risk of adverse clinical course of COVID-19. The most common cause of end stage kidney disease (ESKD) is diabetic kidney disease (DKD). Type 2 Diabetes (T2DM) is a recognized risk factor of COVID-19 adverse outcome regardless of the safety of kidney function. Obesity is widely debated risk factor of adverse outcome of COVID-19.

      Aims

      To study the incidence of obesity and its impact on clinical outcome of COVID-19 in patients on MHD due to DKD.

      Methods

      61 patients with COVID-19 treated from 04.15.20 to 08.20.20 were included in retrospective observational study. All patients were suffering from verified T2DM (the average length >10 y) and ESKD due to DKD. Kidney transplant recipients, patients with acute kidney injury, patients on peritoneal dialysis were not included in the study. Data were collected from electronic data base. The study endpoints were the outcomes of hospitalization – discharge or lethal outcome. Body mass index (BMI), general comorbidity (Charlson index, CCI), vintage of MHD, insulin dependence, plasma albumin level at admission were analyzed.

      Results

      Patient’s mean age 68 ±10 y, females – 56%. General mortality in observation cohort – 40,9% (survivors – 36, nonsurvivors – 25). There was no significant difference in the groups of outcomes in age (69 ±11 y vs 67 ±8 y, р>0,05), gender (females: 20 (55,6%) (survivors) vs 14 (56%) (nonsurvivors), р>0,05) and comorbidity (CCI 8,3 ±1,7 vs CCI 8,7 ±1,5, р>0,05). The MHD vintage median was 3 y (IR 1;5) (3 (IR 1; 5) y vs 3 (IR 1; 5) y, р>0,05). The average plasma albumin level at admission – 32,8 ±4,8 g/L (33,1 ±4,7 g/L vs 32,4 ±5,1 g/L, р>0,05). BMI in observation cohort was 20 – 48 kg/m2. 39 patients (64%) suffered from obesity (BMI ≥30 kg/m2), 15 (38,5%) – males, 24 (61,5%) – females. The average BMI was 31,2 ±5,1 kg/m2 (32,1 ±4,9 kg/m2vs 30,0 ±5,2 kg/m2, р=0,114).
      The analysis of variables BMI/gender in survivors demonstrated the prevalence of BMI ≥30 kg/m2 in males – 68,8% and females – 70% (р >0,05), among nonsurvivors in males – 36,4%, females – 71% (p=0,178) (Fig. 1A, B).
      In general observation cohort 49 patients (80,3%) were treated with insulin (28 (77,8%) vs 21 (84%), р>0,05). BMI≥30 kg/m2was met among insulin depended survivors with the same frequency regardless of gender (males – 7 (58,3%), females – 11 (68,7%), р>0,05). The analysis of variables BMI/gender demonstrated the statistically significant prevalence of insulin-depended females with BMI≥30 kg/m2among nonsurvivors (р=0,019).
      Fig.1 Diagrams A. BMI≥30kg/m2/gender nonsurvivors (general cohort) B. BMI≥30kg/m2/gender nonsurvivors (insulin-depended)

      Conclusions

      The percentage of patients with obesity was 64% in the observation cohort. According to the data received, obesity is not a risk factor of lethal outcome of COVID-19 in patients on MHD due to DKD. Most survivors had BMI≥30 kg/m2. The exception was insulin-depended females with obesity, the number of these patients significantly prevailed among nonsurvivors.
      No conflict of interest