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Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA
Insights
Chronic kidney disease (CKD) significantly increases the risk of severe COVID-19 outcomes and mortality. Urgent action is needed to include CKD patients in clinical trials for COVID-19 treatments and vaccines.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Initial reports on COVID-19 risk factors overlooked chronic kidney disease (CKD).
- Hypertension and cardiovascular disease were initially emphasized over renal disease.
- Emerging data reveals a different risk profile for severe COVID-19.
Purpose of the Study:
- To analyze risk factors for COVID-19 death, focusing on the role of chronic kidney disease (CKD).
- To compare COVID-19 mortality risk in CKD patients versus the general population.
- To advocate for specific actions to protect CKD patients from severe COVID-19.
Main Methods:
- Analysis of large-scale patient data, including the OpenSAFELY project (17 million patients).
- Examination of comorbidities associated with COVID-19 mortality.
- Review of global data, such as the Global Burden of Disease collaboration findings.
Main Results:
- CKD, particularly Stages 4 and 5 (eGFR <30 mL/min/1.73 m2), is a major risk factor for COVID-19 death (aHR 2.52).
- Renal disease, including dialysis and organ transplantation, shows higher mortality risk than diabetes or heart disease.
- CKD is identified as the most prevalent risk factor for severe COVID-19 globally.
Conclusions:
- CKD is a critical, underrecognized risk factor for severe COVID-19 and mortality.
- CKD patients face a disproportionately higher risk of adverse COVID-19 outcomes.
- Inclusion of CKD patients in COVID-19 drug and vaccine clinical trials is essential.
Abstract:
Diabetes, hypertension and cardiovascular disease have been listed as risk factors for severe coronavirus disease 2019 (COVID-19) since the first report of the disease in January 2020. However, this report did not mention chronic kidney disease (CKD) nor did it provide information on the relevance of estimated glomerular filtration rate (eGFR) or albuminuria. As the disease spread across the globe, information on larger populations with greater granularity on risk factors emerged. The recently published OpenSAFELY project analysed factors associated with COVID-19 death in 17 million patients. The picture that arose differs significantly from initial reports. For example, hypertension is not an independent risk factor for COVID-19 death [adjusted hazard ratio (aHR) 0.89], but renal disease very much is. Dialysis (aHR 3.69), organ transplantation (aHR 3.53) and CKD (aHR 2.52 for patients with eGFR <30 mL/min/1.73 m2) represent three of the four comorbidities associated with the highest mortality risk from COVID-19. The risk associated with CKD Stages 4 and 5 is higher than the risk associated with diabetes mellitus (aHR range 1.31-1.95, depending upon glycaemic control) or chronic heart disease (aHR 1.17). In another recent publication, the Global Burden of Disease collaboration identified that worldwide, CKD is the most prevalent risk factor for severe COVID-19. Moreover, the distribution of risk factors for COVID-19 mortality appears to be different in patients with CKD when compared with the general population. The high prevalence of CKD in combination with the elevated risk of mortality from COVID-19 in CKD necessitates urgent action for this group of patients. This article defines essential action points (summarized in Box 1), among which is advocating the inclusion of CKD patients in clinical trials testing the efficacy of drugs and vaccines to prevent severe COVID-19.