From the, Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark.
The Research Department, The Danish Heart Foundation, Copenhagen, Denmark.
J Intern Med. 2021 Jul;290(1):166-178. doi: 10.1111/joim.13239. Epub 2021 Feb 10.
The significance of chronic kidney disease on susceptibility to COVID-19 and subsequent outcomes remains unaddressed.
To investigate the association of estimated glomerular filtration rate (eGFR) on risk of contracting COVID-19 and subsequent adverse outcomes.
Rates of hospital-diagnosed COVID-19 were compared across strata of eGFR based on conditional logistic regression using a nested case-control framework with 1:4 matching of patients diagnosed with COVID-19 with controls from the Danish general population on age, gender, diabetes and hypertension. Risk of subsequent severe COVID-19 or death was assessed in a cohort study with comparisons across strata of eGFR based on adjusted Cox regression models with G-computation of results to determine 60-day risk standardized to the distribution of risk factors in the sample.
Estimated glomerular filtration rate was inversely associated with rate of hospital-diagnosed COVID-19: eGFR 61-90 mL/min/1.73m HR 1.13 (95% CI 1.03-1.25), P = 0.011; eGFR 46-60 mL/min/1.73m HR 1.26 (95% CI 1.06-1.50), P = 0.008; eGFR 31-45 mL/min/1.73m HR 1.68 (95% CI 1.34-2.11), P < 0.001; and eGFR ≤ 30 mL/min/1.73m 3.33 (95% CI 2.50-4.42), P < 0.001 (eGFR > 90 mL/min/1.73m as reference), and renal impairment was associated with progressive increase in standardized 60-day risk of death or severe COVID-19; eGFR > 90 mL/min/1.73m 13.9% (95% CI 9.7-15.0); eGFR 90-61 mL/min/1.73m 16.1% (95% CI 14.5-17.7); eGFR 46-60 mL/min/1.73m 17.8% (95% CI 14.7-21.2); eGFR 31-45 mL/min/1.73m 22.6% (95% CI 18.2-26.2); and eGFR ≤ 30 mL/min/1.73m 23.6% (95% CI 18.1-29.1).
Renal insufficiency was associated with progressive increase in both rate of hospital-diagnosed COVID-19 and subsequent risk of adverse outcomes. Results underscore a possible vulnerability associated with impaired renal function in relation to COVID-19.
慢性肾脏病对 COVID-19 易感性和随后结局的影响仍未得到解决。
研究估算肾小球滤过率（eGFR）与 COVID-19 发病风险和随后不良结局的关系。
采用巢式病例对照研究，以条件逻辑回归比较基于 eGFR 的分层，将丹麦普通人群中 COVID-19 诊断患者与对照以年龄、性别、糖尿病和高血压进行 1:4 匹配。采用调整后的 Cox 回归模型，通过 G 计算结果，在基于 eGFR 的分层中评估随后发生严重 COVID-19 或死亡的风险，以确定 60 天风险标准化为样本中风险因素的分布。
eGFR 与医院诊断 COVID-19 的发生率呈负相关：eGFR 61-90 mL/min/1.73m HR 1.13（95%CI 1.03-1.25），P=0.011；eGFR 46-60 mL/min/1.73m HR 1.26（95%CI 1.06-1.50），P=0.008；eGFR 31-45 mL/min/1.73m HR 1.68（95%CI 1.34-2.11），P<0.001；eGFR≤30 mL/min/1.73m HR 3.33（95%CI 2.50-4.42），P<0.001（eGFR>90 mL/min/1.73m 为参考），肾功能损害与标准化 60 天死亡或严重 COVID-19 风险的逐渐增加相关；eGFR>90 mL/min/1.73m 13.9%（95%CI 9.7-15.0）；eGFR 90-61 mL/min/1.73m 16.1%（95%CI 14.5-17.7）；eGFR 46-60 mL/min/1.73m 17.8%（95%CI 14.7-21.2）；eGFR 31-45 mL/min/1.73m 22.6%（95%CI 18.2-26.2）；eGFR≤30 mL/min/1.73m 23.6%（95%CI 18.1-29.1）。
肾功能不全与医院诊断 COVID-19 的发生率和随后不良结局的风险逐渐增加相关。结果强调了肾功能障碍与 COVID-19 相关的潜在脆弱性。
