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. 2021 Dec 3;3(2):293-306.
doi: 10.34067/KID.0006612021. eCollection 2022 Feb 24.

COVID-19 in Patients with Glomerular Disease: Follow-Up Results from the IRoc-GN International Registry

Meryl Waldman  1 , Maria Jose Soler  2   3 , Clara García-Carro  2   3 , Liz Lightstone  4   5 , Tabitha Turner-Stokes  4   5 , Megan Griffith  5 , Joan Torras  6 , Laura Martinez Valenzuela  6 , Oriol Bestard  2   3 , Colin Geddes  7 , Oliver Flossmann  8 , Kelly L Budge  9 , Chiara Cantarelli  10 , Enrico Fiaccadori  10 , Marco Delsante  10 , Enrique Morales  11 , Eduardo Gutierrez  11 , Jose A Niño-Cruz  12 , Armando J Martinez-Rueda  12 , Giorgia Comai  13 , Claudia Bini  13 , Gaetano La Manna  13 , Maria F Slon  14 , Joaquin Manrique  14 , Alejandro Avello  15   16 , Raul Fernandez-Prado  15   16 , Alberto Ortiz  15   16 , Smaragdi Marinaki  17 , Carmen Rita Martin Varas  18 , Cristina Rabasco Ruiz  19 , Milagros Sierra-Carpio  20 , Rebeca García-Agudo  21 , Gema Fernández Juárez  22 , Alexander J Hamilton  23 , Annette Bruchfeld  24   25 , Constantina Chrysochou  26   27 , Lilian Howard  1 , Smeeta Sinha  26   27 , Tim Leach  28 , Irene Agraz Pamplona  2   3 , Umberto Maggiore  10 , Paolo Cravedi  9
Affiliations

COVID-19 in Patients with Glomerular Disease: Follow-Up Results from the IRoc-GN International Registry

Meryl Waldman et al. Kidney360. .

Abstract

Background: The acute and long-term effects of severe acute respiratory syndrome coronavirus 2 infection in individuals with GN are still unclear. To address this relevant issue, we created the International Registry of COVID-19 infection in GN.

Methods: We collected serial information on kidney-related and -unrelated outcomes from 125 GN patients (63 hospitalized and 62 outpatients) and 83 non-GN hospitalized patients with coronavirus disease 2019 (COVID-19) and a median follow-up period of 6.4 (interquartile range 2.3-9.6) months after diagnosis. We used logistic regression for the analyses of clinical outcomes and linear mixed models for the longitudinal analyses of eGFR. All multiple regression models were adjusted for age, sex, ethnicity, and renin-angiotensin-aldosterone system inhibitor use.

Results: After adjustment for pre-COVID-19 eGFR and other confounders, mortality and AKI did not differ between GN patients and controls (adjusted odds ratio for AKI=1.28; 95% confidence interval [CI], 0.46 to 3.60; P=0.64). The main predictor of AKI was pre-COVID-19 eGFR (adjusted odds ratio per 1 SD unit decrease in eGFR=3.04; 95% CI, 1.76 to 5.28; P<0.001). GN patients developing AKI were less likely to recover pre-COVID-19 eGFR compared with controls (adjusted 6-month post-COVID-19 eGFR=0.41; 95% CI, 0.25 to 0.56; times pre-COVID-19 eGFR). Shorter duration of GN diagnosis, higher pre-COVID-19 proteinuria, and diagnosis of focal segmental glomerulosclerosis or minimal change disease were associated with a lower post-COVID-19 eGFR.

Conclusions: Pre-COVID-19 eGFR is the main risk factor for AKI regardless of GN diagnosis. However, GN patients are at higher risk of impaired eGFR recovery after COVID-19-associated AKI. These patients (especially those with high baseline proteinuria or a diagnosis of focal segmental glomerulosclerosis or minimal change disease) should be closely monitored not only during the acute phases of COVID-19 but also after its resolution.

Keywords: COVID-19; follow-up studies; glomerular and tubulointerstitial diseases; glomerular disease; kidney glomerulus; registries.

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Conflict of interest statement

O. Bestard reports patents and inventions with Oxford Immunotec and is associate editor of Transplant International and Frontiers in Immunology. A. Bruchfeld reports consultancy agreements with AstraZeneca, Chemocentryx, Fresenius, and Merck; a research grant from AstraZeneca; honoraria from Bayer, Chemocentryx, Fresenius, Merck, and Vifor; and is a member of the ERA-EDTA scientific advisory board 2018–2024, chair of the ERA-EDTA Immunonephrology Working Group, and vice-chair of the Swedish Renal Fund. G. Comai reports honoraria from Alexion, Astellas, and Novartis. P. Cravedi reports honoraria as an advisor for Chinook Therapeutics and is associate editor for the Journal of Nephrology and the American Journal of Transplantation. G. Fernandez Juarez reports research funding from Instituto Salud Calos III and honoraria from Alexion and GSK. E. Fiaccadori is on the editorial board of the Journal of Nephrology and Blood Purification and is a member of the Italian Society of Nephrology and the European Society of Parenteral and Enteral Nutrition. O. Flossmann reports consultancy agreements with Vifor Pharma has other interests/relationships with the British Medical Association, European Vasculitis Society, Renal Association (UK), Royal College of Physicians London, and UK Ireland Vasculitis Society. C. García-Carro reports consultancy agreements with Astellas, AstraZeneca, Boehringer Ingelheim Lilly, Esteve, Novartis and Baxter, Novo Nordisk, and Otsuka; honoraria from Astellas, AstraZeneca, Boehringer Ingelheim Lilly, Esteve, Novartis and Baxter, Novo Nordisk, and Otsuka; and is a scientific advisor for or member of AstraZeneca, Boehringer Ingelheim Lilly, Mundipharma, and Novo Nordisk. M. Griffith reports honoraria from Retrophin’s advisory board. A. J. Hamilton is on the editorial board of the Journal of Kidney Care and is a member of the SONG-Kids Life Participation Expert Working Group. T. Leach reports honoraria from Janssen for conference attendance in 2012 and is a scientific advisor to the National Institute for Health and Care Excellence. L. Lightstone reports consultancy agreements with Achillion, Alexion, AstraZeneca, Aurinia, BMS, GSK, Kezar, Novartis, Pfizer, and Roche; honoraria from Alexion, AstraZeneca, BMS, GSK, and Pfizer; is a scientific advisor or member of EU Exec Lupus Nephritis Trials Network; is on the advisory board of Nature Reviews Nephrology; participates in a speakers’ bureau for Alexion and GSK; is a trustee of Kidney Research UK 2018–2022; is an executive member of the International Society of Nephrology 2021–2023; is deputy chair of Western Regional Board of the International Society of Nephrology; and is a clinical expert representing the Renal Association response to NICE on STA for belimumab in lupus 2020–2021. U. Maggiore reports consultancy agreements with Biotest, Chiesi, GSK, Hansa, Novartis, Sandoz, and Takeda. J. Manrique is a scientific advisor for or member of AstraZeneca, Boehringer, and Viphor Pharma. E. Morales reports consultancy agreements with Alexion, Celgene, Viphor Fresenius, and Vifor Pharma. J.A. Niño-Cruz reports research funding from Pfizer Scientific Institute and participates in a speakers’ bureau for Takeda and Roche. A. Ortiz reports consultancy agreements with Retrophin and Sanofi Genzyme; research funding from AstraZeneca, Mundipharma, and Sanofi Genzyme; honoraria from Advicciene, Alexion, Amgen, Amicus, Astellas, AstraZeneca, Bayer, Chiesi, Fresenius Medical Care, Idorsia, Kyowa Kirin, Menarini, Otsuka, Sanofi Genzyme, and Vifor Fresenius Medical Care Renal Pharma; is a member of the Spanish Society of Nephrology; is editor-in-chief of the Clinical Kidney Journal; is on the editorial boards of the Journal of Nephrology, Journal of the American Society of Nephrology, and Peritoneal Dialysis International; is a member of SOMANE and ERA Councils; is on the board of directors for IIS-Fundacion Jimenez Diaz UAM; is on the scientific advisory board of the Dutch Kidney Foundation; honoraria listed above are for speaker engagements: Advicciene, Alexion, Astellas, AstraZeneca, Amicus, Amgen, Bayer, Chiesi, Fresenius Medical Care, Idorsia, Kyowa Kirin, Menarini, Otsuka, Sanofi Genzyme, and Vifor Fresenius Medical Care Renal Pharma. S. Sinha reports consultancy agreements with Sanifit; research funding from Amgen, AstraZeneca, and Ethicon; and honoraria from AstraZeneca, Bayer, Napp Pharmaceuticals, Novartis, and Sanofi Genzyme. M.F. Slon-Roblero reports consultancy agreements with Baxter, Fresenius, and Nipro; and honoraria from Baxter, Fresenius, and Nipro. M.J. Soler reports consultancy agreements with AstraZeneca, Bayer, Boehringer, Esteve, Jansen, Mundipharma, Novo Nordisk, Travere, and ICU; research funding from Abbvie and Boehringer; honoraria from AstraZeneca, Boehringer, Esteve, FMC, Jansen, ICU Medical, Mundipharma, Novo Nordisk, Otsuka, and Travere; patents and inventions: U691ES00; is a scientific advisor for or member of BMC Nephrology and Clinical Kidney Journal; is a former member of ERA-EDTA Council; participates in a speakers’ bureau for AstraZeneca, Bayer, Boehringer, Esteve, FMC, Jansen, Mundipharma, Novo Nordisk, and Vifor; is a member of the Sociedad Española de Nefrología and Sociedad Catalana de Nefrologia; and is elected editor-in-chief of the Clinical Kidney Journal. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Probability of developing AKI as a function of eGFR before coronavirus disease 2019 (COVID-19). The probability is based on a regression model, which is adjusted for age, sex, non-White ethnicity, and use of renin-angiotensin-aldosterone system inhibitors. The model is estimated only in hospitalized patients with glomerular disease. The shadowed area represents the 95% confidence interval (CI). The adjusted odds ratio of AKI per 1 SD unit decreases in eGFR (approximately 15 ml/min per 1.73 m2) was 2.88 (95% CI, 1.38 to 6.02; P=0.005).
Figure 2.
Figure 2.
Visual representation of the results of the four-way interaction term from the longitudinal mixed model on eGFR between GN and Ctrl hospitalized patients, time, AKI, and pre-COVID-19 eGFR (P=0.02). The figure represents the predicted relationship between pre- and post-COVID-19 eGFR after stratification of hospitalized patients according to the absence (left panel) and presence (right panel) of a history of glomerular disease (Ctrl hospitalized and GN hospitalized, respectively, throughout the text). Patients are additionally stratified on the basis of those who did not develop (blue) or who developed (red) AKI during their hospital stay. The dotted gray line represents the line of identity between pre- and post-COVID-19 eGFR (i.e., full recovery of kidney function). Although Ctrl hospitalized patients had a full recovery of eGFR at 6 months after COVID-19, the recovery was only partial in GN hospitalized patients who developed AKI during their hospital stay. For all of the groups, except GN hospitalized patients who had AKI, the coefficient between pre-COVID-19 and 6-month post-COVID-19 was close to one and the line close to the line of identity: Ctrl hospitalized patients without AKI: 0.90 (95% CI, 0.75 to 1.04); GN hospitalized patients without AKI: 0.87 (95% CI, 0.70 to 1.04); Ctrl hospitalized patients with AKI: 0.98 (95% CI, 0.82 to 1.14); GN hospitalized patients with AKI: 0.41 (95% CI, 0.25 to 0.56; see Supplemental Table 4). The visual representation of the four-way interaction term as eGFR change over time is reported in Supplemental Figure 3.
See this image and copyright information in PMC

References

    1. Waldman M, Soler MJ, García-Carro C, Lightstone L, Turner-Stokes T, Griffith M, Torras J, Valenzuela LM, Bestard O, Geddes C, Flossmann O, Budge KL, Cantarelli C, Fiaccadori E, Delsante M, Morales E, Gutierrez E, Niño-Cruz JA, Martinez-Rueda AJ, Comai G, Bini C, La Manna G, Slon MF, Manrique J, Agraz I, Sinaii N, Cravedi P: Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring. Kidney Int 99: 227–237, 2021. 10.1016/j.kint.2020.10.032 - DOI - PMC - PubMed
    1. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN; REDCap Consortium : The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 95: 103208, 2019. 10.1016/j.jbi.2019.103208 - DOI - PMC - PubMed
    1. Fu EL, Janse RJ, de Jong Y, van der Endt VHW, Milders J, van der Willik EM, de Rooij ENM, Dekkers OM, Rotmans JI, van Diepen M: Acute kidney injury and kidney replacement therapy in COVID-19: A systematic review and meta-analysis. Clin Kidney J 13: 550–563, 2020. 10.1093/ckj/sfaa160 - DOI - PMC - PubMed
    1. Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, Paranjpe I, Somani S, Richter F, Miotto R, Lala A, Kia A, Timsina P, Li L, Freeman R, Chen R, Narula J, Just AC, Horowitz C, Fayad Z, Cordon-Cardo C, Schadt E, Levin MA, Reich DL, Fuster V, Murphy B, He JC, Charney AW, Böttinger EP, Glicksberg BS, Coca SG, Nadkarni GN; Mount Sinai COVID Informatics Center (MSCIC) : AKI in hospitalized patients with COVID-19. J Am Soc Nephrol 32: 151–160, 2021. 10.1681/ASN.2020050615 - DOI - PMC - PubMed
    1. Ng JH, Hirsch JS, Hazzan A, Wanchoo R, Shah HH, Malieckal DA, Ross DW, Sharma P, Sakhiya V, Fishbane S, Jhaveri KD; Northwell Nephrology COVID-19 Research Consortium : Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis 77: 204–215.e1, 2021. 10.1053/j.ajkd.2020.09.002 - DOI - PMC - PubMed

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