Nephrol Dial Transplant. 2021 Jan 1;36(1):87-94. doi: 10.1093/ndt/gfaa314.
Diabetes, hypertension and cardiovascular disease have been listed as risk factors for severe coronavirus disease 2019 (COVID-19) since the first report of the disease in January 2020. However, this report did not mention chronic kidney disease (CKD) nor did it provide information on the relevance of estimated glomerular filtration rate (eGFR) or albuminuria. As the disease spread across the globe, information on larger populations with greater granularity on risk factors emerged. The recently published OpenSAFELY project analysed factors associated with COVID-19 death in 17 million patients. The picture that arose differs significantly from initial reports. For example, hypertension is not an independent risk factor for COVID-19 death [adjusted hazard ratio (aHR) 0.89], but renal disease very much is. Dialysis (aHR 3.69), organ transplantation (aHR 3.53) and CKD (aHR 2.52 for patients with eGFR <30 mL/min/1.73 m2) represent three of the four comorbidities associated with the highest mortality risk from COVID-19. The risk associated with CKD Stages 4 and 5 is higher than the risk associated with diabetes mellitus (aHR range 1.31-1.95, depending upon glycaemic control) or chronic heart disease (aHR 1.17). In another recent publication, the Global Burden of Disease collaboration identified that worldwide, CKD is the most prevalent risk factor for severe COVID-19. Moreover, the distribution of risk factors for COVID-19 mortality appears to be different in patients with CKD when compared with the general population. The high prevalence of CKD in combination with the elevated risk of mortality from COVID-19 in CKD necessitates urgent action for this group of patients. This article defines essential action points (summarized in Box 1), among which is advocating the inclusion of CKD patients in clinical trials testing the efficacy of drugs and vaccines to prevent severe COVID-19.
自 2020 年 1 月首次报告该疾病以来，糖尿病、高血压和心血管疾病已被列为严重 2019 冠状病毒病（COVID-19）的危险因素。然而，该报告并未提及慢性肾脏病（CKD），也未提供有关估计肾小球滤过率（eGFR）或蛋白尿的相关性信息。随着该疾病在全球范围内的传播，出现了更多关于具有更大粒度危险因素的更大人群的信息。最近发表的 OpenSAFELY 项目分析了 1700 万例患者中与 COVID-19 死亡相关的因素。出现的情况与最初的报告有很大的不同。例如，高血压不是 COVID-19 死亡的独立危险因素（调整后的危险比[aHR]0.89），但肾脏疾病是。透析（aHR3.69）、器官移植（aHR3.53）和 CKD（eGFR<30mL/min/1.73m2 的患者 aHR2.52）是与 COVID-19 死亡率最高相关的四种合并症中的三种。CKD 第 4 期和第 5 期的风险高于糖尿病（aHR 范围 1.31-1.95，取决于血糖控制）或慢性心脏病（aHR1.17）的风险。在另一篇最近的出版物中，全球疾病负担合作组织确定，在全球范围内，CKD 是严重 COVID-19 的最常见危险因素。此外，与一般人群相比，CKD 患者 COVID-19 死亡率的危险因素分布似乎不同。CKD 的高患病率加上 CKD 患者 COVID-19 死亡率的升高，需要对这组患者采取紧急行动。本文定义了基本行动要点（总结在框 1 中），其中包括主张将 CKD 患者纳入临床试验，以测试预防严重 COVID-19 的药物和疫苗的疗效。
