Autosomal dominant polycystic kidney disease does not exacerbate COVID-19 complications
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Autosomal dominant polycystic kidney disease did not increase the risk for major COVID-19 complications, including the need for dialysis, compared with other cystic kidney disease or cystic liver disease.
The study, which involved a cohort of U.S. veterans, also showed the condition was not associated with increased risk for hospitalization, ICU admission, ventilator requirement or mortality.
“The assessment of the direct effects of [chronic kidney disease] CKD on COVID-19 outcomes is complicated by the interweaving relationships among CKD causes and COVID-19 risk factors,” Xiangqin Cui, PhD, of Rollins School of Public Health at Emory University, and colleagues wrote. For example, obesity is a risk factor for CKD onset and progression. It also increases the risk for other CKD risk factors, such as type 2 diabetes mellitus (T2DM), hypertension, and autoimmune disorders. Notably, obesity, T2DM, and immunosuppression (commonly used treatment of autoimmune disorders) are all risk actors of severe illness from COVID-19. Therefore, it is difficult to delineate between the COVID-19 risks attributable to CKD and the risks attributable to CKD’s underlying causes and their complications.”
The researchers contended that because autosomal dominant polycystic kidney disease (ADPKD) is the fourth leading cause of CKD and ESKD, considering the condition may “reveal CKD’s direct effects on major COVID-19 outcomes with limited confounding effects by other medical complications.”
For the study, Cui and colleagues included 61 veterans with ADPKD who tested positive for COVID-19. Within 60 days of testing, outcomes were compared between this cohort and two control groups: those who had other cystic kidney disease (eg, simple renal cysts) or cystic liver disease only (defined as having no renal cysts).
Patients with ADPKD had a higher rate of kidney-related preexisting conditions, including acute kidney failure, CKD stage and dialysis requirement.
Researchers noted that they used the highest-documented CKD stage within 2 years before the COVID-19 testing date for their analysis and controlled for patient age, BMI, prior CKD, type 2 diabetes, dialysis, cancer and liver problems.
Results showed ADPKD did not reach statistical significance as an independent risk factor for any of the COVID-19 outcomes.
“Although,” the researchers wrote, “an odds ratio (OR) of greater than one was estimated for hospitalization (1.52), ICU admission (1.93), and ventilator requirement (1.71) and might reach statistical significance when more data is available.”
Similar to previous studies, researchers found type 2 diabetes was the greatest independent risk factor for hospitalization (OR = 2.39), ICU admission (OR = 2.33) and ventilator requirement (OR = 2.32).
Regarding the need for dialysis, findings indicated ADPKD was not associated with starting the treatment; the leading risk factors for dialysis initiation were preexisting CKD (OR = 6.37) and Black race (OR =3.47).
“[T]his study suggests that ADPKD is not a robust risk factor for the major COVID-19 outcomes among veterans when compared to other cystic kidney or liver diseases,” Cui and colleagues concluded. “However, this initial study will require validation when larger numbers of COVID-19 positive patients become available.”
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