INTRODUCTION
The Coronavirus Disease-2019 (COVID19) pandemic has led to radical
shifts in the delivery of healthcare. To minimize the risk of
person-to-person transmission, particularly in the nosocomial setting,
attempts have been made to increase utilization of telehealth(1). Yet,
many aspects of healthcare require in-person interactions. This is
particularly true for urologic oncology patients as chemotherapy
infusions, radiation therapy, surgical expatriation, and radiologic
surveillance are components of routine care. Furthermore, the
time-sensitive nature of malignancy makes delays in care problematic for
many patients.
To this end, several collaborative reviews have been published on
strategies for the appropriate triage of patients with urologic
malignancy during the COVID19 pandemic(2-4). These recommendations are
largely based on the existing literature regarding the natural history
of individual urologic malignancies. For highly aggressive malignancies
such as muscle invasive bladder cancer, significant delays in care are
clearly unacceptable(5). Similarly, for those malignancies with a more
indolent behavior such as low-risk prostate cancer, delays and
modifications to routine care are unlikely to produce significant
adverse outcomes(6). However, for moderately aggressive malignancies
such as intermediate-risk and high-risk prostate cancer, non-muscle
invasive bladder cancer, and most kidney cancers, the risks and benefits
of delaying and modifying care should be based both on the natural
history of the cancer, and the natural history of COVID-19 in these
patients and cancer patients in general.
Indeed, several large population-based studies from various countries
have suggested malignancy is associated with adverse outcomes in COVID19
patients(7-9). Furthermore, studies from cancer centers and cancer
consortiums have evaluated the natural history of COVID19 in larger
cohorts of cancer patients and found a mortality rate ranging from
12%-28%(10-12). Interestingly, malignancy type did not appear to be a
significant predictor of mortality. However, a notable limitation of the
existing literature is that many studies utilized small cohorts of
cancer patients or did not have a control group of patients without a
cancer diagnosis. Furthermore, though our understanding of COVID19 and
cancer has continued to evolve, little is known about the impact of
cancer history on the risk of developing acute kidney injury (AKI) in
COVID19 patients. AKI occurs in an estimated 4.5-8.9% of COVID19
cases(13, 14). AKI increases the risk of developing CKD(15), which is
concerning for cancer patients as many oncologic therapies may result in
renal impairment(16). Additionally, in patients with genitourinary
malignancies, CKD has been associated with adverse post-operative
outcomes(17-19).
Our academic medical system includes several hospitals and outpatient
clinics throughout the New York City area, which has been one of the
world’s most afflicted locations and in turn has treated a large
population of COVID19 patients. Accordingly, in the present study, we
seek to evaluate COVID19 patients treated within our academic medical
system to determine if history of malignancy, both in general and
specifically in genitourinary oncology patients, is associated with
clinical outcomes, including AKI and mortality.