Afro-Caribbean patients with end stage kidney disease more likely to be hospitalized with COVID-19

Afro-Caribbean people with end stage kidney disease (ESKD) are more likely to be hospitalized with COVID-19 than other ethnicities, a study has found.

Research published today in Nephrology by King's College London and Guy's and St Thomas' NHS Foundation Trust investigated the link between ethnicity and ESKD. They found patients of Afro-Caribbean ethnicity have a four-fold increased risk of being hospitalized with COVID-19 when compared to kidney transplant patients attending for routine care.

The study examined 39 people with diabetes-related ESKD hospitalized with COVID-19 at Guy's and St Thomas' between March and April 2020. Of the hospitalized cohort, 73% of patients with a kidney transplant and 54% of hemodialysis patients were of Afro-Caribbean ethnicity. By comparison in patients attending hospital for routine care 18% of kidney transplant patients and 42% of hemodialysis patients are of Afro-Caribbean ethnicity.

The study concluded that ESKD is associated with a high mortality rate of 36% among severely ill patients hospitalized with COVID-19.

There is very little information on the clinical features and outcomes in patients with ESKD admitted with COVID-19 in the UK. Patients with ESKD are at high risk of severe COVID-19 and often have a poor prognosis. The mortality rate of patients hospitalized, as they had very severe COVID-19, was high at 36% and similar to other recent studies internationally. We observed a disproportionately high prevalence of people of Afro-Caribbean ethnicity being hospitalized. We also saw that low blood glucose levels (hypoglycemia) were common during hospitalization in this high-risk population and that adjustment of diabetes treatment was frequently required."

Dr Antonella Corcillo, first author of the study, School of Cardiovascular Medicine and Sciences at King's College London

Senior author, Dr Janaka Karalliedde from King's College London, said: "People with ESKD are a high-risk group and are vulnerable to severe COVID-19 infection. When we compared the prevalence of Afro-Caribbean ethnicity in kidney transplant patients admitted with severe COVID-19 to the population of transplant patients attending for routine care at our hospital we observed a more than a four-fold increase in patients of Afro-Caribbean origin being admitted with COVID-19. Further studies and research are urgently required to understand and explain this observation of disproportionate risk in patients of Afro-Caribbean origin. Our data also confirm that the management of diabetes in the setting of severe COVID-19 infection is very challenging and reinforce the importance of integrated multidisciplinary care and teamwork for patients with diabetes hospitalized with COVID-19."

Limitations of this study include its relatively small sample size and that, as it is a cross-sectional study, it is unable to identify causal relationships between ethnicity and severe COVID-19 outcomes.