Understanding the Burden of the COVID-19 Pandemic for People With Kidney Disease

Abstract

H ealth authorities worldwide began to recognize the enormity of the coronavirus disease 2019 pandemic late in the first quarter of 2020. The daunting public health implications of the pandemic for people with kidney disease has since become increasingly clear. Indeed, reports on the impact of COVID-19 in people with kidney disease have appeared at a rate unprecedented in the history of nephrology.In this issue of AJKD, the report by Chung et al 1 provides important insights into 2 questions of supreme importance: What is the incidence of COVID-19 in people with kidney disease? and What is the association between COVID-19 and death in people with kidney disease? The investigators found that the incidence of COVID-19 in patients with chronic kidney disease (CKD) treated with dialysis was 105 per 10,000 person-weeks; in patients with CKD not requiring kidney replacement therapy (KRT), 16 per 10,000 person-weeks; and in kidney transplant recipients (KTRs), 23 per 10,000 person-weeks. Compared with patients with CKD without KRT, therefore, incidence of COVID-19 is roughly 6 times higher in maintenance dialysis patients and roughly oneand-a-half times higher in KTRs. Regarding the issue of risk of death associated with COVID-19 among people with kidney disease, the authors report that, compared with patients receiving dialysis who did not have COVID-19, the incidence rate ratio (IRR) for death in affected dialysis patients was approximately 8. Analogously, KTRs with COVID-19 had an IRR for death of 42 compared with KTRs who did not have COVID-19. (Owing to a lack of suitable studies, IRRs for CKD without KRT could not be estimated.)Quantifying the incidence of COVID-19 and COVID-19-related death is obviously of crucial importance, yet generating insights into the relationship between kidney disease and risk of these outcomes is more complex than it first appears. If the goal is to determine the additional risks for COVID-19 and COVID-19-related death associated with kidney disease, merely comparing rates among people with kidney disease to rates in the general population may be inadequate. This is because people with kidney disease have high rates of accompanying comorbid conditions such as diabetes, atherosclerotic vascular disease, heart failure, and others that are themselves likely to confer increased risk for COVID-19 and COVID-19-related death. An early indication that kidney disease is a risk factor for COVID-19-related death emerged from the UK's National Health Service

Clinical Outcomes and Vaccine Effectiveness for SARS-CoV-2 Infection in People Attending Advanced CKD Clinics

“…7,8,11,29 A potential confounder to these relationships is that older patients with more comorbidities may be more likely to get tested because of more symptomatic illness or more frequent hospitalization. 5,6 We found that non-White ethnicity, lower income, and residency in long-term care homes were associated with a higher risk of infection, as has been previously reported in the maintenance dialysis population. 1 This emphasizes the importance of socioeconomic factors in COVID-19 infection.…”

“…CKD is a strong risk factor for severe coronavirus disease 2019 (COVID-19)–related outcomes including hospitalization and all-cause mortality. 1–10 People on maintenance dialysis and with kidney transplants were identified early in the pandemic as subgroups at higher risk for severe outcomes and were prioritized in global vaccination efforts. 11,12…”

“…CKD is a strong risk factor for severe coronavirus disease 2019 (COVID-19)-related outcomes including hospitalization and all-cause mortality. [1][2][3][4][5][6][7][8][9][10] People on maintenance dialysis and with kidney transplants were identified early in the pandemic as subgroups at higher risk for severe outcomes and were prioritized in global vaccination efforts. 11,12 People with nondialyzed CKD also have high COVID-19 case fatality rates compared with the general population, although systematic reviews suggest that both infection risk and fatality rates are lower overall compared with those in people receiving maintenance dialysis.…”

“…11,12 People with nondialyzed CKD also have high COVID-19 case fatality rates compared with the general population, although systematic reviews suggest that both infection risk and fatality rates are lower overall compared with those in people receiving maintenance dialysis. [5][6][7] However, early papers from Italy and Turkey reported that fatality rates were similarly high in people with CKD stages 3-5. 10,11 In general, studies in this area have been small, have had varying proportions of people with CKD stages 3-5, and cannot always distinguish risk of infection from risk of fatality, making interpretation difficult.…”

Comparative analysis of the glomerular filtration rate effect on the course of COVID-19 in patients with coronary heart disease with and without concomitant coronavirus disease

“…The study's author provides similar statistics, stating that the mortality rate in such patients increases by 20-30%. J.B. Wetmore [22] presented information that about 4.0% of patients on renal replacement therapy who are hospitalised for a cardiovascular event die in the hospital and another 4.5% of discharged patients die within the next 30 days. It has also been proven that not all patients with COVID-19 can be hospitalised and, therefore, are not included in trials, so the mortality rate is likely to be even higher.…”