Atiquzzaman Mohammad, Er Lee, Djurdjev Ognjenka, Zheng Yuyan, Wong Michelle M Y, Birks Peter C, Bevilacqua Micheli U, Yau Kevin, Hladunewich Michelle A, Oliver Matthew J, Levin Adeera
BC Renal, Vancouver, British Columbia, Canada.
Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
Nephrol Dial Transplant. 2025 Aug 29;40(9):1717-1726. doi: 10.1093/ndt/gfaf040.
We investigated the long-term effect of COVID-19 on estimated glomerular filtration rate (eGFR) trajectory and the association with progression to kidney failure in patients with CKD.
Patients living with non-dialysis-dependent CKD from British Columbia, Canada infected with COVID-19 (cases) were matched 1:2 to non-COVID-19-infected controls on variables including pre-COVID-19 annual rate of eGFR decline. Patients were followed from 90 days from the date of COVID-19 diagnosis. The Cox proportional hazard model was used for the primary outcome of kidney failure, defined as a composite of eGFR reaching <15 ml/min/1.73 m2, initiation of maintenance dialysis or kidney transplantation. A linear mixed regression model was used to calculate the annual rate of change in eGFR.
The study included 802 patients: 268 cases and 534 controls. The median age was 70 years and 54% were male. Over ≈3 years of follow-up, the risk of developing kidney failure did not differ significantly between cases and controls. The annual rate of eGFR decline was 2.05 ml/min/1.73 m2 among cases versus 1.35 ml/min/1.73 m2 among controls, representing a rate difference of 0.71 ml/min/1.73 m2 (P = .02).
In patients with non-dialysis-dependent CKD who survived at least 90 days without requiring dialysis, COVID-19 was not associated with an increased long-term risk of kidney failure over 3 years but was associated with a greater annual decline in eGFR. Future research with longer follow-up is required to examine if this difference persists and leads to increased risk for kidney failure.
我们研究了新冠病毒病（COVID-19）对估计肾小球滤过率（eGFR）轨迹的长期影响以及与慢性肾脏病（CKD）患者进展至肾衰竭的相关性。
来自加拿大不列颠哥伦比亚省、感染COVID-19的非透析依赖性CKD患者（病例组）与未感染COVID-19的对照组按1:2进行匹配，匹配变量包括COVID-19感染前eGFR的年下降率。自COVID-19诊断之日起对患者进行90天的随访。采用Cox比例风险模型评估肾衰竭这一主要结局，肾衰竭定义为eGFR降至<15 ml/min/1.73 m²、开始维持性透析或进行肾移植的复合情况。使用线性混合回归模型计算eGFR的年变化率。
该研究纳入了802例患者，其中268例为病例组，534例为对照组。中位年龄为70岁，男性占54%。在约3年的随访期内，病例组和对照组发生肾衰竭的风险无显著差异。病例组eGFR的年下降率为2.05 ml/min/1.73 m²，对照组为1.35 ml/min/1.73 m²，率差为0.71 ml/min/1.73 m²（P = 0.02）。
在至少90天内无需透析且存活的非透析依赖性CKD患者中，COVID-19与3年内肾衰竭的长期风险增加无关，但与eGFR每年更大幅度的下降有关。需要进行更长随访期的未来研究，以检验这种差异是否持续存在并导致肾衰竭风险增加。
