Autosomal Dominant Polycystic Kidney Disease does not significantly alter major COVID-19 outcomes among veterans

Abstract

Chronic kidney disease (CKD), as well as its common causes (e.g., diabetes and obesity), are recognized risk factors for severe COVID-19 illness. To explore whether the most common inherited cause of CKD, autosomal dominant polycystic kidney disease (ADPKD), is also an independent risk factor, we studied data from the VA health system and the VA COVID-19-shared resources (e.g., ICD codes, demographics, pre-existing conditions, pre-testing symptoms, and post-testing outcomes). Among 61 COVID-19-positive ADPKD patients, 21 (34.4%) were hospitalized, 10 (16.4%) were admitted to ICU, 4 (6.6%) required ventilator, and 4 (6.6%) died by August 18, 2020. These rates were comparable to patients with other cystic kidney diseases and cystic liver-only diseases. ADPKD was not a significant risk factor for any of the four outcomes in multivariable logistic regression analyses when compared with other cystic kidney diseases and cystic liver-only diseases. In contrast, diabetes was a significant risk factor for hospitalization [OR 2.30 (1.61, 3.30), p<0.001], ICU admission [OR 2.23 (1.47, 3.42), p<0.001], and ventilator requirement [OR 2.20 (1.27, 3.88), p=0.005]. Black race significantly increased the risk for ventilator requirement [OR 2.00 (1.18, 3.44), p=0.011] and mortality [OR 1.60 (1.02, 2.51), p=0.040]. We also examined the outcome of starting dialysis after COVID-19 confirmation. The main risk factor for starting dialysis was CKD [OR 6.37 (2.43, 16.7)] and Black race [OR 3.47 (1.48, 8.1)]. After controlling for CKD, ADPKD did not significantly increase the risk for newly starting dialysis comparing with other cystic kidney diseases and cystic liver-only diseases. In summary, ADPKD did not significantly alter major COVID-19 outcomes among veterans when compared to other cystic kidney and liver patients.

Cross-validation of SARS-CoV-2 responses in kidney organoids and clinical populations

“…Similarly, PKD cysts, which feature a more squamous epithelium, contain cells expressing ACE2 and LTL that are susceptible to SARS-CoV-2 infection, which likely derive from proximal tubules ( 37 ). The extent of infection observed in cystic organoids is similar to that in control (noncystic) organoids, suggesting that PKD neither enhances nor protects against SARS-CoV-2, consistent with a clinical report in which patients with autosomal dominant PKD did not have significantly increased major COVID-19 outcomes ( 68 ). Evidence of cytotoxicity was more readily discerned in PKD cysts than in noncystic tubules, although this may be attributable to improved optics in the cysts.…”

The Impact of COVID-19 on Patients With ADPKD

“…Symptoms in those affected with COVID-19 were no different in those with ADPKD compared with those with non-ADPKD cystic kidney or liver disease. 6 While the data remain very limited, the biggest risk factor for COVID-19 is exposure to SARS-CoV-2, and it is unlikely that ADPKD significantly modifies this risk.…”

“…A report first distributed as an unpublished preprint analysis did not show an increase in hospitalization, intensive care unit admission, intubation, or mortality following COVID-19 infection in patients with ADPKD compared with patients with other cystic kidney or cystic liver diseases. 6 It should be noted that preprint reports have not been peer reviewed but are a growing resource for early access to research results, 7 and this report was subsequently published. 8 Of 709 veterans with ADPKD tested for COVID-19 in Atlanta in January 2020, 61 (8.6%) had a positive test and were compared to 9817 veterans with non-ADPKD cystic kidney or liver disease tested for COVID-19 of which 803 (8.2%) had a positive test.…”