Association Between CKD, Obesity, Cardiometabolic Risk Factors, and Severe COVID-19 Outcomes

Area of Science:

• Nephrology
• Infectious Diseases
• Epidemiology

Background:

• Chronic kidney disease (CKD) is a known risk factor for severe COVID-19.
• Underlying mechanisms linking CKD to severe COVID-19 are not fully understood.
• Common risk factors for CKD, such as diabetes and obesity, also increase COVID-19 severity.

Purpose of the Study:

• To investigate the association between CKD and severe COVID-19 outcomes.
• To examine the influence of body mass index (BMI) and diabetes on the CKD-COVID-19 relationship.
• To determine if CKD poses a risk for severe COVID-19 independent of BMI and diabetes status.

Main Methods:

• Nationwide case-control study utilizing mandatory national registries.
• Inclusion of 4684 intensive care unit (ICU) patients with mechanical ventilation (cases) and 46,840 matched population controls.
• Logistic regression analysis to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for confounders and stratified by BMI and diabetes status.

Main Results:

• CKD was significantly associated with severe COVID-19 (OR, 2.20), ICU continuous renal replacement therapy (OR, 7.36), and death post-ICU admission (OR, 2.51).
• The risk of severe COVID-19 associated with CKD was not significantly modified by BMI.
• CKD posed a higher risk for severe COVID-19 in individuals without diabetes (OR, 2.76) compared to those with diabetes (OR, 1.88).

Conclusions:

• CKD, particularly end-stage CKD, is a substantial risk factor for severe COVID-19.
• The elevated risk of severe COVID-19 and associated mortality in CKD patients persists even with normal BMI and in the absence of type 2 diabetes.
• These findings underscore the importance of considering CKD status in managing COVID-19 patients.