Determinants and mortality associated with renal dysfunction among SARS-CoV-2 infected patients at KCMC Referral Hospital, North-Eastern Tanzania

Abstract

Background: Renal dysfunction is a common manifestation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and contributes to increased mortality. However, data on its determinants and associated mortality within Sub-Saharan Africa (SSA) remain limited.
Methods: This hospital-based retrospective cohort study analysed data for 504 patients with confirmed SARSCoV-2 infection who were admitted at the Kilimanjaro Christian Medical Centre (KCMC) between 10th March 2020 and 26th January 2022. Data were extracted from electronic medical records and Stata v18 was used for data analysis. Logistic regression identified factors associated with renal dysfunction, and Cox regression analyzed mortality predictors.
Results: The mean age was 62.7 ± 17.4 years and 56.3% were males. The most common comorbidities were hypertension (48.8%) and diabetes mellitus (30.2%). The median serum creatinine was 96 μmol/L (IQR 73.5 - 141.5 μmol/L). Renal dysfunction was found in 215 (42.6%) patients. Confusion (65.5%) and severe COVID disease (48.7%) were the most common clinical presentations among those with renal dysfunction. Factors significantly associated with renal dysfunction included age over 60 years (AOR 2.11, 95% CI 1.09 – 4.07), male sex (AOR 1.56, 95% CI 1.07 – 2.67), and hypertension (AOR 1.51 ,95% CI 1.02 - 2.24). Mortality was more frequent among patients
with renal dysfunction compared to those without (45% vs. 20%, P < 0.001). After adjustment, renal dysfunction (AHR 2.21, 95% (1.81 – 3.62), patients age over 60 years (AHR 4.00, 95% CI 1.92– 8.34) and COVID disease severity (AHR 4.29, 95% CI 2.04–9.02) were independently associated with mortality.
Conclusions: Renal dysfunction is prevalent in SARS-CoV-2 patients and is associated with older age, male sex, and hypertension. Mortality is high among these patients, particularly those aged over 60 years. These findings identify a high-risk group requiring prioritized care and further studies for targeted interventions.