Chronic kidney disease (CKD) is associated with an increased risk of both, inpatient and outpatient pneumonia.  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. 
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. 
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.
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- Collins AJ, Foley RN, Gilbertson DT, Chen S-C. The State of Chronic Kidney Disease, ESRD, and Morbidity and Mortality in the First Year of Dialysis. CJASN. 2009;4:S5–11.
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- Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708–20.
- Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63:364–74.
- 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.
- 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.
- 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.