Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA

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.

Multivariable mortality risk prediction using machine learning for COVID-19 patients at admission (AICOVID)

“…The odds of mortality in these comorbid conditions are provided in Table 1 , comparable with the meta-analysis conducted by Kumar et al 17 . Hazard ratios associated with Chronic Kidney Disease (3.04, CI 1.72–5.38) (Prevalence 6.2%) shows the higher associated risk with comparable results from ERA-EDTA Council and the ERACODA Working Group 18 . The prevalence of Chronic Liver Disease (3.95, CI 1.16–13.42) was comparatively lower than other comorbidities, and hence hazard ratio is higher than other studies 19 .…”

Impact of Kidney Failure on the Severity of COVID-19

“…Patients with CKD are highly susceptible to COVID-19 and are at an increased risk of progression to a severe or critical form of the disease because of impaired immunity; additionally, they are at enhanced risk of SARS-CoV-2 infection due to frequent hospital attendance [ 2 , 13 , 14 , 15 , 16 , 17 , 18 ]. The prevalence of CKD in patients with COVID-19 has been reported in a wide range of approximately 1–47%; however, it is suggested that the lowest values result from underestimation [ 16 , 19 , 20 , 21 ]. Among patients with COVID-19 hospitalized in 30 Polish centers included in the current analysis, nearly 20% were diagnosed with CKD, of which 18% presented severe renal failure.…”

A simple, home-therapy algorithm to prevent hospitalisation for COVID-19 patients: A retrospective observational matched-cohort study

“…We predefined potential baseline confounders, such as age, sex, and concomitant diseases that potentially enhance the risk of severe COVID-19 illness [18] , [19] , [20] .…”