Another face of the long COVID: kidney disease
In April 2021, we published the largest comprehensive review providing a systematic characterization of all post-acute sequelae of COVID-19. The study showed that beyond the acute phase of the disease, COVID-19 can cause several extrapulmonary manifestations, including acute and chronic kidney disease. Following the publication of this study, we have received numerous requests from patients, scientists, physicians and other stakeholders in the nephrology community urging us to perform a dedicated analysis that delves into the long-term consequences of infection with the kidney. COVID-19 on Kidney Health and Disease. . This led us to conduct the largest study to date involving 89,216 people with COVID-19 and 1,637,467 uninfected controls to assess the risks of several kidney outcomes (including acute and chronic kidney disease) in phase post-acute COVID-19.
What we know
In this study, recently published in the Journal of the American Society of Nephrology, my colleagues and I have found that in the post-acute phase of the disease, people with COVID-19 are at increased risk for acute kidney failure, chronic kidney disease, and end-stage kidney disease. We reported that this increased risk is evident even in people with mild illness that did not require hospitalization during the acute phase of infection – these patients represent the majority of people with COVID-19. We also found that the risk was higher in people who needed to be hospitalized and higher in those who needed intensive care during the acute phase of the disease.
Our studies estimate that about 13.44 per 1,000 people with COVID-19 develop some form of kidney injury or disease. Given that nearly 44 million people have been infected with COVID-19 in the United States, we estimate that more than half a million people will suffer from some form of kidney disease as a result of a long COVID. . This will add to the already substantial burden of kidney disease in the United States
Our studies also show a remarkable loss in estimated glomerular filtration rate (eGFR) in people who survive the acute phase of COVID-19. Among those who were not hospitalized for COVID-19 during the acute phase of the illness, they experienced loss of eGFR attributable to COVID-19 at an annualized rate of -3.26 ml / min / 1.73 m2 – the equivalent of aging for an additional 3 years. Among those who were hospitalized, eGFR loss attributable to COVID-19 was greater than 7.69 ml / min / 1.73 m2 – the equivalent of aging for more than 7 additional years.
While we still don’t fully understand why SARS-CoV-2 – a respiratory virus – induces large-scale extrapulmonary organ dysfunction, including acute and chronic kidney damage and loss of kidney function, the broader implications evidence is clear. COVID-19 will significantly contribute to an increased incidence of acute kidney injury and chronic kidney disease. Healthcare providers, healthcare systems and governments need to be aware of this reality and need to develop strategies for the early identification and treatment of these patients. The overall goal would be to reduce the risk of progression to more severe forms of kidney disease and to alleviate the cardiometabolic consequences and early death that typically characterize advanced chronic kidney disease.
The cost of developing early detection and prevention strategies will certainly help contain much higher downstream costs in terms of loss of life and cost of care for end-stage renal disease.
Long-COVID is a multi-faceted disease. It is now quite clear that some clinical manifestations of long-term COVID, such as fatigue, may go away over time in some people; But it is also very clear that a long duration of COVID leads to chronic diseases such as chronic kidney disease (and other noncommunicable diseases such as heart failure and recent-onset diabetes). These are manageable – but not curable – diseases that will affect people for the rest of their lives. And all of these conditions are associated with an increased need for health resource use, reduced quality of life, increased risk of death, and reduced life expectancy. The additional burden of kidney disease and other noncommunicable diseases will have far-reaching implications, not only on health outcomes and life expectancy, but also on social, economic and political issues more broadly.
COVID-19 will cast a long shadow in the form of a long COVID that will shape our lives for decades to come. We were caught off guard for COVID-19 and provided a dismal public health response that took a heavy toll of suffering, illness and death – much of it that could have been avoided. Let’s learn from our failure and prepare to face the long COVID.
Ziyad Al-Aly, MD, is a medical scientist, clinical epidemiologist and longtime COVID researcher. He is the director of the Center for Clinical Epidemiology and the head of the research and development department of the veterans health care system in St. Louis, Missouri.