COVID-19 increased rapid kidney function decline in patients with CKD
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Key takeaways:
- Seventy-six percent of patients experienced worsened eGFR during the pandemic.
- Notably, 2.5% of those with COVID-19 experienced rapid kidney function decline.
Among patients with stages 3-4 chronic kidney disease, a COVID-19 infection increased the odds of rapid kidney function decline during the pandemic, according to a study.
However, the long-term impact of infection-related eGFR decline needs more review, researchers said.
“Rapid kidney function decline has been associated with cardiovascular events, hospitalization, onset of end-stage kidney failure and mortality,” Clarissa J. Diamantidis, MD, MHS, an associate professor of medicine at the Duke University School of Medicine in St. Durham, North Carolina, and colleagues wrote. At the same time, "the direct and indirect effects of the COVID-19 pandemic on kidney function in the [chronic kidney disease] CKD population are not well understood,” they wrote. “We sought to characterize changes in kidney function trajectories in the pandemic era compared with the pre-pandemic trends ... and to identify factors associated with rapid kidney function decline.”
Investigators of the retrospective cohort study used de-identified administrative claims and laboratory data from Medicare Advantage and commercially insured enrollees with CKD stages 3-4 from 2018 to 2021. Researchers conducted a propensity score matching to identify a COVID-19-infected cohort and compared it with a matched group without the infection.
Among 97,203 patients, 9% experienced the COVID-19 infection. Primary outcome was rapid kidney function weakening and annual eGFR decline of greater than or equal to 40%.
Results showed the median overall annual eGFR change was –2.65 mL/min/1.73m², and 76% of the patients experienced worsened eGFR during the pandemic.
Respectively, 1.9% and 2% of enrollees in the pre-pandemic and pandemic periods experienced rapid kidney function decline, according to the study. Notably, 2.5% of those with COVID-19 experienced rapid kidney function decline, compared with 1.5% in the non-infected group.
Several factors were associated with increased odds of pandemic rapid kidney function decline, the researchers said, including Asian race, higher Charlson Comorbidity Index, advancing CKD stage, pre-pandemic rapid kidney function decline and COVID-19 infection.
The pandemic “resulted in rates of rapid kidney function decline comparable with pre-pandemic values exacerbated by COVID-19 infection, suggesting reduced kidney function may be both a risk factor for, and a consequence of, COVID-19,” the researchers wrote.
The study had limitations due to its retrospective design, they indicated, which may have introduced potential bias. Moreover, further research may shed light on the downstream effects of pandemic-related eGFR declines, such as kidney failure or mortality, they wrote.
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