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All COVID-19 patients must be monitored for kidney damage in post-COVID period

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Dr Georgi Abraham, Professor & Senior Consultant, Dept. of Nephrology, MGM Healthcare, Chennai    04 September 2021

People who have had COVID-19 are more likely to develop kidney damage including chronic kidney disease (CKD) and end-stage kidney disease. Even mild infections are susceptible to impairment of kidney function. These findings from a new study were published online September 1 in the Journal of the American Society of Nephrology.1

Researchers analysed health data from more than 1.7 million US Veterans from March 1, 2020, through March 15, 2021. This data included those who had had confirmed COVID-19 30-days back as well as healthy veterans; 89,216 30-day COVID-19 survivors and 1,637,467 non-infected controls. Around 14% of COVID-19 patients needed admission to hospital and around 5% were hospitalized in ICU. The aim of the study was to evaluate the risk of AKI, eGFR decline, ESKD, and major adverse kidney events (MAKE; eGFR decline ≥50%) or all-cause mortality.

Patients who had Covid-19 but did not require hospitalization were 30% more likely to develop acute kidney injury and 15% greater risk of a major adverse kidney event such as CKD. They were also at a more than two-fold higher risk of developing end-stage renal disease (ESRD).

Whereas, patients who had been hospitalized, particularly those who needed intensive care were at a much higher risk. They were at 7-folds greater risk of suffering a major adverse kidney event, at 8-folds higher risk of acute kidney injury and at 13-fold increased risk of end-stage kidney disease.

Hospitalized patients, but not requiring intensive care, doubled their risk of decline in eGFR of ≥30%, while ICU patients at 3-times greater risk of decrease in eGFR. However, a finding of note was that persons with mild COVID-19 showed a decline in eGFR; the risk of eGFR decline was estimated to be 1.09 times higher in them.

Some people who have had COVID-19 continue to have symptoms even after they have recovered from the infection. Long-Covid or post-acute Covid is a recognized entity now and kidney damage is an important part of the constellation of signs and symptoms. A recent Lancet study has shown that symptoms persisted even after one year of recovery from Covid-19.

This study has demonstrated that it is not just persons who had been hospitalized during the course of their illness, but even those with mild disease are at risk of kidney damage and dysfunction. All COVID-19 patients require regular monitoring of kidney function to anticipate and prevent kidney damage.

Reference

  1. Bowe B, et al. Kidney outcomes in long COVID. Journal of the American Society of Nephrology, 2021; ASN.2021060734 DOI: 10.1681/ASN.2021060734

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