The Impact of COVID-19 on Patients With ADPKD

Abstract

Purpose of review: Patients with autosomal dominant polycystic kidney disease (ADPKD) have kidney cysts and kidney enlargement decades before progressing to advanced chronic kidney disease (CKD), meaning patients live most of their adult life with a chronic medical condition. The coronavirus disease 2019 (COVID-19) pandemic has created common questions among patients with ADPKD. In this review, we discuss COVID-19 concerns centered around a patient with a common clinical vignette. Sources of information: We performed PubMed and Google scholar searches for English, peer-reviewed studies related to “COVID-19,” “ADPKD,” “CKD,” “tolvaptan,” “angiotensin-converting enzyme inhibitors” (ACEi), “angiotensin receptor blockers” (ARB), and “vaccination.” We also evaluated transplant data provided by the Ontario Trillium Gift of Life Network. Methods: Following an assessment of available literature, this narrative review addresses common questions of patients with ADPKD in the context of the COVID-19 pandemic. Key findings: Data regarding the risk of developing COVID-19 and the risk of adverse COVID-19 outcomes in patients with ADPKD remain limited, but patients with ADPKD with impaired estimated glomerular filtration rate (eGFR), kidney transplants, or on dialysis are likely at similar increased risk as those with generally defined CKD. We provide strategies to improve virtual care, which is likely to persist after the pandemic. Current evidence suggests ACEi, ARB, and tolvaptan treatment should be continued unless contraindicated due to severe illness. When available, and in the absence of a severe allergy, vaccination is recommended for all patients with ADPKD. Limitations: This narrative review is limited by a paucity of high-quality data on COVID-19 outcomes in patients specifically with ADPKD. Implications: Patients with ADPKD who have developed advanced CKD, require dialysis, or who have received a kidney transplant are at elevated risk of COVID-19 complications.

COVID-19 Infection in Autosomal Dominant Polycystic Kidney Disease and Chronic Kidney Disease Patients: Progression of Kidney Disease

“…While data remain quite limited, there is no evidence to suggest ADPKD increases the likelihood of hospitalization, dialysis, or mortality over and above the risk conferred by the degree of CKD. Other study have not shown 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 [ 1 , 4 , 5 ]. While both conditions involve kidney dysfunction, the etiology, progression, and management strategies differ significantly.…”

“…Additionally, the systemic effects of COVID-19, such as hypoxia and coagulopathy, may further compromise kidney health in ADPKD patients [ 5 ]. Moreover, it is known that SARS-CoV-2 virus utilizes ACE2 receptors on cell membranes to determine the damage, and it is well-documented that the RAAS is more active in ADPKD patients [ 1 ]. The use of ACEIs and ARBs in the context of COVID-19 has been a subject of significant debate and research.…”

“…It is characterized by the development of fluid-filled cysts within the kidneys which can progressively enlarge and impair kidney function over time. Individuals with ADPKD may experience a range of symptoms, including high blood pressure, kidney pain, and, in some cases, kidney failure [ 1 ]. The emergence of the COVID-19 pandemic has raised concerns about how this novel coronavirus might impact individuals with preexisting medical conditions, including ADPKD and CKD.…”

“…Additionally, the chronic nature of ADPKD means that these patients are at a heightened risk of severe complications from COVID-19, further aggravating their renal condition [ 4 ]. Furthermore, the common use of drug treatments involving ACE inhibitors (ACEi) or angiotensin receptor blockers (ARBs) in these patients introduces other clinical implications [ 1 ]. Managing COVID-19 in patients with ADPKD requires careful monitoring and treatment adjustments to address both the viral infection and the underlying renal condition.…”

COVID-19-Omics Report: From Individual Omics Approaches to Precision Medicine

“…Combining individual omics data with demographical/ethnic data and prior health conditions (patients' phenomes) allowed for the identification of genes and molecular pathways involved in COVID-19 hospitalization cases [142,149]. Strong associations were identified between multiome biomarkers and individuals' pre-existing conditions, such as kidney disease, ischemic heart disease, cerebrovascular disease, and hypertension [150,151].…”