Post by Nadica (She/Her) on Oct 23, 2024 1:46:33 GMT
Kidney Outcomes in Long COVID - Published Nov 2021
Abstract
Significance Statement
Patients who survive coronavirus disease 2019 (COVID-19) are at higher risk of post-acute sequelae involving pulmonary and several extrapulmonary organ systems—generally referred to as long COVID. However, a detailed assessment of kidney outcomes in long COVID is not yet available. Here we show that, beyond the acute phase of illness, 30-day survivors of COVID-19 exhibited higher risks of AKI, eGFR decline, ESKD, major adverse kidney events (MAKE), and steeper longitudinal decline in eGFR. The risks of kidney outcomes increased according to the severity of the acute infection (categorized by care setting into non-hospitalized, hospitalized, and admitted to intensive care). The findings provide insight into the long-term consequences of COVID-19 on kidney outcomes and suggest that post-acute COVID-19 care should include attention to kidney function and disease.
Background
COVID-19 is associated with increased risk of post-acute sequelae involving pulmonary and extrapulmonary organ systems—referred to as long COVID. However, a detailed assessment of kidney outcomes in long COVID is not yet available.
Methods
We built a cohort of 1,726,683 US Veterans identified from March 1, 2020 to March 15, 2021, including 89,216 patients who were 30-day survivors of COVID-19 and 1,637,467 non-infected controls. We examined risks of AKI, eGFR decline, ESKD, and major adverse kidney events (MAKE). MAKE was defined as eGFR decline ≥50%, ESKD, or all-cause mortality. We used inverse probability–weighted survival regression, adjusting for predefined demographic and health characteristics, and algorithmically selected high-dimensional covariates, including diagnoses, medications, and laboratory tests. Linear mixed models characterized intra-individual eGFR trajectory.
Results
Beyond the acute illness, 30-day survivors of COVID-19 exhibited a higher risk of AKI (aHR, 1.94; 95% CI, 1.86 to 2.04), eGFR decline ≥30% (aHR, 1.25; 95% CI, 1.14 to 1.37), eGFR decline ≥40% (aHR, 1.44; 95% CI, 1.37 to 1.51), eGFR decline ≥50% (aHR, 1.62; 95% CI, 1.51 to 1.74), ESKD (aHR, 2.96; 95% CI, 2.49 to 3.51), and MAKE (aHR, 1.66; 95% CI, 1.58 to 1.74). Increase in risks of post-acute kidney outcomes was graded according to the severity of the acute infection (whether patients were non-hospitalized, hospitalized, or admitted to intensive care). Compared with non-infected controls, 30-day survivors of COVID-19 exhibited excess eGFR decline (95% CI) of −3.26 (−3.58 to −2.94), −5.20 (−6.24 to −4.16), and −7.69 (−8.27 to −7.12) ml/min per 1.73 m2 per year, respectively, in non-hospitalized, hospitalized, and those admitted to intensive care during the acute phase of COVID-19 infection.
Conclusions
Patients who survived COVID-19 exhibited increased risk of kidney outcomes in the post-acute phase of the disease. Post-acute COVID-19 care should include attention to kidney disease.
Abstract
Significance Statement
Patients who survive coronavirus disease 2019 (COVID-19) are at higher risk of post-acute sequelae involving pulmonary and several extrapulmonary organ systems—generally referred to as long COVID. However, a detailed assessment of kidney outcomes in long COVID is not yet available. Here we show that, beyond the acute phase of illness, 30-day survivors of COVID-19 exhibited higher risks of AKI, eGFR decline, ESKD, major adverse kidney events (MAKE), and steeper longitudinal decline in eGFR. The risks of kidney outcomes increased according to the severity of the acute infection (categorized by care setting into non-hospitalized, hospitalized, and admitted to intensive care). The findings provide insight into the long-term consequences of COVID-19 on kidney outcomes and suggest that post-acute COVID-19 care should include attention to kidney function and disease.
Background
COVID-19 is associated with increased risk of post-acute sequelae involving pulmonary and extrapulmonary organ systems—referred to as long COVID. However, a detailed assessment of kidney outcomes in long COVID is not yet available.
Methods
We built a cohort of 1,726,683 US Veterans identified from March 1, 2020 to March 15, 2021, including 89,216 patients who were 30-day survivors of COVID-19 and 1,637,467 non-infected controls. We examined risks of AKI, eGFR decline, ESKD, and major adverse kidney events (MAKE). MAKE was defined as eGFR decline ≥50%, ESKD, or all-cause mortality. We used inverse probability–weighted survival regression, adjusting for predefined demographic and health characteristics, and algorithmically selected high-dimensional covariates, including diagnoses, medications, and laboratory tests. Linear mixed models characterized intra-individual eGFR trajectory.
Results
Beyond the acute illness, 30-day survivors of COVID-19 exhibited a higher risk of AKI (aHR, 1.94; 95% CI, 1.86 to 2.04), eGFR decline ≥30% (aHR, 1.25; 95% CI, 1.14 to 1.37), eGFR decline ≥40% (aHR, 1.44; 95% CI, 1.37 to 1.51), eGFR decline ≥50% (aHR, 1.62; 95% CI, 1.51 to 1.74), ESKD (aHR, 2.96; 95% CI, 2.49 to 3.51), and MAKE (aHR, 1.66; 95% CI, 1.58 to 1.74). Increase in risks of post-acute kidney outcomes was graded according to the severity of the acute infection (whether patients were non-hospitalized, hospitalized, or admitted to intensive care). Compared with non-infected controls, 30-day survivors of COVID-19 exhibited excess eGFR decline (95% CI) of −3.26 (−3.58 to −2.94), −5.20 (−6.24 to −4.16), and −7.69 (−8.27 to −7.12) ml/min per 1.73 m2 per year, respectively, in non-hospitalized, hospitalized, and those admitted to intensive care during the acute phase of COVID-19 infection.
Conclusions
Patients who survived COVID-19 exhibited increased risk of kidney outcomes in the post-acute phase of the disease. Post-acute COVID-19 care should include attention to kidney disease.