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. 2021 Jul;290(1):166-178.
doi: 10.1111/joim.13239. Epub 2021 Feb 10.

Increased vulnerability to COVID-19 in chronic kidney disease

N Carlson  1   2 , K-E Nelveg-Kristensen  1 , E Freese Ballegaard  1 , B Feldt-Rasmussen  1 , M Hornum  1 , A-Lise Kamper  1 , G Gislason  2   3 , C Torp-Pedersen  4
Affiliations

Increased vulnerability to COVID-19 in chronic kidney disease

N Carlson et al. J Intern Med. 2021 Jul.

Abstract

Background: The significance of chronic kidney disease on susceptibility to COVID-19 and subsequent outcomes remains unaddressed.

Objective: To investigate the association of estimated glomerular filtration rate (eGFR) on risk of contracting COVID-19 and subsequent adverse outcomes.

Methods: Rates of hospital-diagnosed COVID-19 were compared across strata of eGFR based on conditional logistic regression using a nested case-control framework with 1:4 matching of patients diagnosed with COVID-19 with controls from the Danish general population on age, gender, diabetes and hypertension. Risk of subsequent severe COVID-19 or death was assessed in a cohort study with comparisons across strata of eGFR based on adjusted Cox regression models with G-computation of results to determine 60-day risk standardized to the distribution of risk factors in the sample.

Results: Estimated glomerular filtration rate was inversely associated with rate of hospital-diagnosed COVID-19: eGFR 61-90 mL/min/1.73m2 HR 1.13 (95% CI 1.03-1.25), P = 0.011; eGFR 46-60 mL/min/1.73m2 HR 1.26 (95% CI 1.06-1.50), P = 0.008; eGFR 31-45 mL/min/1.73m2 HR 1.68 (95% CI 1.34-2.11), P < 0.001; and eGFR ≤ 30 mL/min/1.73m2 3.33 (95% CI 2.50-4.42), P < 0.001 (eGFR > 90 mL/min/1.73m2 as reference), and renal impairment was associated with progressive increase in standardized 60-day risk of death or severe COVID-19; eGFR > 90 mL/min/1.73m2 13.9% (95% CI 9.7-15.0); eGFR 90-61 mL/min/1.73m2 16.1% (95% CI 14.5-17.7); eGFR 46-60 mL/min/1.73m2 17.8% (95% CI 14.7-21.2); eGFR 31-45 mL/min/1.73m2 22.6% (95% CI 18.2-26.2); and eGFR ≤ 30 mL/min/1.73m2 23.6% (95% CI 18.1-29.1).

Conclusions: Renal insufficiency was associated with progressive increase in both rate of hospital-diagnosed COVID-19 and subsequent risk of adverse outcomes. Results underscore a possible vulnerability associated with impaired renal function in relation to COVID-19.

Keywords: COVID-19; estimated glomerular filtration rate; renal insufficiency.

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Conflict of interest statement

The results presented in this paper have not been published previously in whole or part. The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Cohort study: Standardized risk of severe COVID‐19 or death stratified by eGFR in patients with hospital‐diagnosed COVID‐19.
See this image and copyright information in PMC

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