COVID-19 Long-Haulers at Risk of Developing Kidney Damage & Chronic Disease

By Washington University in St. Louis September 3, 2021

A study by researchers from Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System shows that people who have had COVID-19, including those with mild cases, are at an increased risk of developing COVID-19. kidney damage, because as well as chronic and end-stage kidney diseases.

Attention to kidneys important part of post-COVID-19 care.

Research continues to mount, indicating that many people who have had COVID-19 suffer from a range of adverse conditions months after their initial infections. A deep dive into federal health data adds to those concerns, pointing to a significant decline in kidney function in those called COVID-19 long-haul carriers — and even those who had mild infections from the virus.

The data, collected by researchers from Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System, shows that those infected with SARS-CoV-2 have an increased chance of developing kidney damage. and end-stage chronic and renal disease.

The study was published online Sept. 1 in the Journal of the American Society of Nephrology.

Known as the silent killer, kidney dysfunction and disease are usually free of pain and other symptoms — so much so that the National Kidney Foundation estimates that 90% of people with diseased kidneys don’t know it. Kidney disease affects 37 million people in the US and is one of the leading causes of death in the country.

“Our findings highlight the critical importance of paying attention to kidney function and disease in the care of patients who have had COVID-19,” said senior author Ziyad Al-Aly, MD, an assistant professor of medicine at Washington University. “If kidney care is not integral to the COVID-19 strategy for post-acute care, we will miss opportunities to help potentially hundreds of thousands of people who have no idea that their kidney function has declined as a result of this virus. This is in addition to the millions of Americans suffering from kidney disease not caused by COVID-19.”

The findings coincide with an increase in COVID-19 infections, spurred by the delta variant. Since the start of the pandemic, more than 38 million people have been diagnosed with the virus.

“Based on our research, we believe that 510,000 of those people who have had COVID-19 may have kidney injury or kidney disease,” Al-Aly said.

The researchers analyzed anonymized medical records in a database maintained by the U.S. Department of Veterans Affairs, the largest integrated health care delivery system in the country. The researchers created a controlled dataset containing health information from more than 1.7 million healthy and COVID-infected veterans from March 1, 2020 to March 15, 2021. Of those veterans, 89,216 had confirmed COVID-19 diagnoses and the acute phase (the first 30 days of the disease).

The COVID-19 patients in the study were mostly male and in their late 60s; however, the researchers also analyzed data from 151,289 women — including 8,817 with COVID-19 — and adults of all ages. Of the COVID-19 patients, 12,376 (13.9%) required hospitalization, including 4,146 (4.6%) who were admitted to intensive care units (ICUs).

“The risk of reduced kidney function is greatest in people who were in the ICU; however, it is important to note that the risk extends to all patients, even those who had milder cases of COVID-19,” said Al-Aly, who is also director of the Clinical Epidemiology Center and head of the Research and Education Service. at the Veterans Affairs St. Louis Healthcare System.

Earlier stages of kidney disease can often be treated with medication.

“It is essential to detect kidney dysfunction before the problem progresses and becomes more difficult to treat,” Al-Aly said. “But kidney problems are silent problems that are not found until someone checks the blood work. Based on our research, it is especially important that healthcare providers do this for people who have had COVID-19. Otherwise we will miss a lot of people and unfortunately we will have to deal with more advanced kidney disease later on.”

Compared to patients who did not become infected, people who contracted the virus but did not require hospitalization had a 15% higher risk of suffering from serious kidney disease such as chronic kidney disease, a 30% higher risk of acute kidney injury, and a 215% (more than twofold) higher risk of developing end-stage kidney disease. The latter occurs when the kidneys can no longer effectively remove waste products from the body. In such cases, dialysis or a kidney transplant is needed to keep patients alive.

The risk increased for patients hospitalized for COVID-19, and significantly for those in ICU due to the virus: seven times the risk of severe kidney disease, eight times the risk of acute kidney injury, and 13 times the risk of acute kidney injury. risk of end-stage renal disease.

“People who have been hospitalized for COVID-19 or need ICU care are most at risk,” Al-Aly said. “But the risk is not zero for those who had milder cases. In fact, it is significant. And we must not forget that we do not yet know the health implications for long-haul carriers in the coming years.”

After the first 30 days of COVID-19 infection, 4,757 (5.3%) of patients experienced a 30% or greater decrease in glomerular filtration rates (GFR), which physicians use to assess renal function and, if appropriate, determine the severity of kidney disease. The rate is determined by a simple blood test that measures levels of creatinine, a waste product in the blood that is filtered by the kidneys and discarded in the urine.

The researchers found that people with milder cases of COVID-19 had a 1.09 times greater risk of an estimated GFR drop of 30% or more. For hospitalized COVID-19 patients who were not in intensive care units, there was twice the risk of an estimated GFR drop of 30% or more, while patients in intensive care had a three-fold risk of an estimated GFR drop of 30% or more. GFR drop of 30% or more.

“The kidney damage was greater than the reduced function caused by normal aging,” explained Al-Aly. “The kidney function of a 60-year-old is less robust than the kidneys of a 20-year-old. The decline in renal function that we have observed in these patients is not graceful aging. It’s nothing normal. It is certainly a disease condition.

“Kidney disease is an important facet of the multifaceted long-term COVID-19,” he said. “It is a critical part of the long COVID-19 story and should be taken into account when caring for people with a long COVID-19 virus.”

Reference: “Kidney Outcomes in Lung COVID” by Benjamin Bowe, Yan Xie, Evan Xu, and Ziyad Al-Aly, September 1, 2021, Journal of the American Society of Nephrology.
DOI: 10.1681/ASN.2021060734

This research was funded by the US Department of Veterans Affairs; the American Society of Nephrology; and the KidneyCure Foundation.