Chronic kidney disease is associated with severe COVID-19 infection

Chronic kidney disease (CKD) is associated with an increased risk of both, inpatient and outpatient pneumonia. [1] Pneumonia in CKD patients is associated with increased hospitalization, cardiovascular events [2,3], and mortality. [4,5] The pneumonia related mortality rate of patients with CKD is 14 to 16-fold higher than that of the general population. [5]

A meta-analysis was performed to explore the potential association between CKD and severity of COVID-19 infection. The meta-analysis is based on available data from four studies, which included 1389 COVID-19 patients; 273 (19.7%) were classified as having severe disease. [6–9]

Based on the individual consideration, no study found CKD as significant clinical predictor of severe COVID-19. However, when combining data from individual studies, a significant association of CKD with severe COVID-19 was observed.

The exact mechanism of kidney involvement in COVID-19 is unclear: postulated mechanisms include sepsis leading to cytokine storm syndrome or direct cellular injury due to the virus. [10]

Observed kidney abnormalities associated with increased hospital mortality in COVID-19 patients include proteinuria, hematuria, elevated serum creatinine, elevated blood urea nitrogen and an estimated glomerular filtration rate (GFR) < 60 ml/minute/1.73 m2.

CKD patients with suspected COVID-19 should be closely monitored for timely detecting signs of disease progression.

References

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  2. Guo H, Liu J, Collins AJ, Foley RN. Pneumonia in incident dialysis patients--the United States Renal Data System. Nephrology Dialysis Transplantation. 2007;23:680–6.
  3. Viasus D, Garcia-Vidal C, Cruzado JM, Adamuz J, Verdaguer R, Manresa F, et al. Epidemiology, clinical features and outcomes of pneumonia in patients with chronic kidney disease. Nephrology Dialysis Transplantation. 2011;26:2899–906.
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  8. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323:1061.
  9. Zhang J, Dong X, Cao Y, Yuan Y, Yang Y, Yan Y, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020;all.14238.
  10. Naicker S, Yang C-W, Hwang S-J, Liu B-C, Chen J-H, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney International. 2020;97:824–8.