Diamantidis Clarissa J, Cook David J, Redelosa Cyd Kristoff, Vinculado Rachell B, Cabajar Alden A, Vassalotti Joseph A
Duke University School of Medicine, Durham, NC.
OptumLabs, Eden Prairie, MN.
Kidney Med. 2023 Jul 26;5(9):100701. doi: 10.1016/j.xkme.2023.100701. eCollection 2023 Sep.
RATIONALE & OBJECTIVE: The direct and indirect effects of the coronavirus disease 2019 (COVID-19) pandemic on kidney function in the chronic kidney disease (CKD) population are not well understood.
Cohort study.
SETTING & PARTICIPANTS: Retrospective study of kidney function trajectories using deidentified administrative claims and laboratory data for Medicare Advantage and commercially insured enrollees with CKD stages G3-4 between 2018 and 2021.
COVID-19 infection.
Rapid kidney function decline defined as annual estimated glomerular filtration rate (eGFR) decline of ≥40%.
Propensity score matching was used to identify individuals without COVID-19 infection matched 1:1 to a COVID-19 infected cohort and indexed on the date of diagnosing COVID-19 infection, age, sex, race or ethnicity, and Charlson comorbidity index score. Outpatient kidney function was compared during the prepandemic period (January 1, 2018, to February 29, 2020) with the pandemic period (March 1, 2020, to August 31, 2021). Two creatinine measurements, after the infection date and ≥60 days apart, were required to reduce correlation with acute infection.
Of 97,203 enrollees with CKD G3-4, 9% experienced a COVID-19 infection. Characteristics of 8,901 propensity matched enrollees include mean age 74 years, 58% women, 67% White, and 63% CKD G3a, 28% CKD G3b, and 9% CKD G4. Median overall annual eGFR change was -2.65 ml/min/1.73m, with 76% of the cohort experiencing worsened eGFR in the pandemic period. Rapid kidney function decline was observed in 1.9% and 2.0% of enrollees in the prepandemic and pandemic periods, respectively. Rapid kidney function decline was observed in 2.5% of those with COVID-19 infection and 1.5% of those without COVID-19 infection ( 0.05). Factors associated with increased odds of rapid kidney function decline during pandemic included Asian race, higher Charlson comorbidity index, advancing CKD stage, prepandemic rapid kidney function decline, and COVID-19 infection.
Retrospective study design with potential bias.
COVID-19 infection increased odds of rapid kidney function decline during the pandemic. The downstream impact of pandemic-related eGFR decline on health outcomes, such as kidney failure or mortality, requires further study.
PLAIN-LANGUAGE SUMMARY: We used a cohort of insured individuals with moderate-to-severe chronic kidney disease (CKD) to compare the rates of rapid kidney function decline in prepandemic and pandemic periods and to evaluate the impact of the coronavirus disease 19 (COVID-19) on kidney function decline. We found that overall rates of rapid kidney function decline did not change during the prepandemic and pandemic periods but were significantly higher in both periods among individuals with a COVID-19 infection. As CKD severity increased, rates of both rapid kidney function decline and COVID-19 increased. Advancing CKD, higher comorbid condition, Asian race, prepandemic rapid kidney function decline, and COVID-19 were all associated with higher odds of rapid kidney function decline in the pandemic. These findings suggest close monitoring is warranted for individuals with CKD and COVID-19.
2019年冠状病毒病（COVID-19）大流行对慢性肾脏病（CKD）人群肾功能的直接和间接影响尚未完全明确。
队列研究。
利用2018年至2021年间医疗保险优势计划和商业保险参保的CKD G3-4期患者的匿名管理索赔和实验室数据，对肾功能轨迹进行回顾性研究。
COVID-19感染。
将估算肾小球滤过率（eGFR）年下降≥40%定义为肾功能快速下降。
采用倾向评分匹配法，将未感染COVID-19的个体与感染COVID-19的队列按1:1匹配，并以诊断COVID-19感染的日期、年龄、性别、种族或族裔以及查尔森合并症指数评分作为指标。比较大流行前时期（2018年1月1日至2020年2月29日）和大流行时期（2020年3月1日至2021年8月31日）的门诊肾功能。需要在感染日期后进行两次肌酐测量，且间隔≥60天，以减少与急性感染的相关性。
在97203例CKD G3-4期参保者中，9%感染了COVID-19。8901例倾向评分匹配的参保者的特征包括平均年龄74岁，女性占58%，白人占67%，CKD G3a占63%，CKD G3b占28%，CKD G4占9%。总体年eGFR变化中位数为-2.65ml/min/1.73m²，76%的队列在大流行期间eGFR恶化。在大流行前和大流行期间，分别有1.9%和2.0%的参保者出现肾功能快速下降。在感染COVID-19的人群中以及未感染COVID-19的人群中，分别有2.5%和1.5%的人出现肾功能快速下降（P<0.05）。与大流行期间肾功能快速下降几率增加相关的因素包括亚洲种族、查尔森合并症指数较高、CKD分期进展、大流行前肾功能快速下降以及COVID-19感染。
回顾性研究设计存在潜在偏倚。
COVID-19感染增加了大流行期间肾功能快速下降的几率。大流行相关的eGFR下降对健康结局（如肾衰竭或死亡率）的下游影响需要进一步研究。
我们利用一组中度至重度慢性肾脏病（CKD）的参保个体，比较了大流行前和大流行期间肾功能快速下降的发生率，并评估了2019年冠状病毒病（COVID-19）对肾功能下降的影响。我们发现，大流行前和大流行期间肾功能快速下降的总体发生率没有变化，但在感染COVID-19的个体中，这两个时期的发生率均显著更高。随着CKD严重程度的增加，肾功能快速下降和COVID-19感染的发生率均上升。CKD进展、合并症情况较重、亚洲种族、大流行前肾功能快速下降以及COVID-19感染均与大流行期间肾功能快速下降的较高几率相关。这些发现表明，对患有CKD和COVID-19的个体进行密切监测是必要的。
