Meryl Waldman1, Maria Jose Soler2,3, Clara García-Carro2,3, Liz Lightstone4,5, Tabitha Turner-Stokes4,5, Megan Griffith5, Joan Torras6, Laura Martinez Valenzuela6, Oriol Bestard2,3, Colin Geddes7, Oliver Flossmann8, Kelly L Budge9, Chiara Cantarelli10, Enrico Fiaccadori10, Marco Delsante10, Enrique Morales11, Eduardo Gutierrez11, Jose A Niño-Cruz12, Armando J Martinez-Rueda12, Giorgia Comai13, Claudia Bini13, Gaetano La Manna13, Maria F Slon14, Joaquin Manrique14, Alejandro Avello15,16, Raul Fernandez-Prado15,16, Alberto Ortiz15,16, Smaragdi Marinaki17, Carmen Rita Martin Varas18, Cristina Rabasco Ruiz19, Milagros Sierra-Carpio20, Rebeca García-Agudo21, Gema Fernández Juárez22, Alexander J Hamilton23, Annette Bruchfeld24,25, Constantina Chrysochou26,27, Lilian Howard1, Smeeta Sinha26,27, Tim Leach28, Irene Agraz Pamplona2,3, Umberto Maggiore10, Paolo Cravedi9. 1. Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. 2. Servei Nefrologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. 3. Grup de Recerca de Nefrología, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. 4. Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, United Kingdom. 5. Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom. 6. Nephrology Department, Bellvitge University Hospital, Clinical Science Department, Barcelona University, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. 7. Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom. 8. Department of Nephrology, Royal Berkshire Hospital, Reading, United Kingdom. 9. Department of Medicine, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York. 10. Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. 11. Departamento de Nefrología, Hospital Universitario 12 de Octubre/Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain. 12. Departamento de Nefrología y Metabolismo Mineral Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. 13. Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria de Bologna, Alma Mater Studiorum University of Bologna, Italy, Bologna, Italy. 14. Hospital Universitario de Navarra, Pamplona, Spain. 15. Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain. 16. Nephrology and Hypertension, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain. 17. Clinic of Nephrology and Renal Transplantation, NKUA, Medical School, Laiko General Hospital, Athens, Greece. 18. Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain. 19. Hospital Universitario Reina Sofía, Cordoba, Spain. 20. Hospital San Pedro, Logroño La Rioja, Spain. 21. Nephrology Department La Mancha-Centro Hospital, Alcázar de San Juan, Ciudad Real, Spain. 22. Nephrology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain. 23. Renal Unit, Royal Devon and Exeter NHS Foundation Trust, United Kingdom. 24. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. 25. Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden. 26. Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom. 27. Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom. 28. Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.
Abstract
Background: The acute and long-term effects of severe acute respiratory syndrome coronavirus 2 infection in individuals with GN are still unclear. To address this relevant issue, we created the International Registry of COVID-19 infection in GN. Methods: We collected serial information on kidney-related and -unrelated outcomes from 125 GN patients (63 hospitalized and 62 outpatients) and 83 non-GN hospitalized patients with coronavirus disease 2019 (COVID-19) and a median follow-up period of 6.4 (interquartile range 2.3-9.6) months after diagnosis. We used logistic regression for the analyses of clinical outcomes and linear mixed models for the longitudinal analyses of eGFR. All multiple regression models were adjusted for age, sex, ethnicity, and renin-angiotensin-aldosterone system inhibitor use. Results: After adjustment for pre-COVID-19 eGFR and other confounders, mortality and AKI did not differ between GN patients and controls (adjusted odds ratio for AKI=1.28; 95% confidence interval [CI], 0.46 to 3.60; P=0.64). The main predictor of AKI was pre-COVID-19 eGFR (adjusted odds ratio per 1 SD unit decrease in eGFR=3.04; 95% CI, 1.76 to 5.28; P<0.001). GN patients developing AKI were less likely to recover pre-COVID-19 eGFR compared with controls (adjusted 6-month post-COVID-19 eGFR=0.41; 95% CI, 0.25 to 0.56; times pre-COVID-19 eGFR). Shorter duration of GN diagnosis, higher pre-COVID-19 proteinuria, and diagnosis of focal segmental glomerulosclerosis or minimal change disease were associated with a lower post-COVID-19 eGFR. Conclusions: Pre-COVID-19 eGFR is the main risk factor for AKI regardless of GN diagnosis. However, GN patients are at higher risk of impaired eGFR recovery after COVID-19-associated AKI. These patients (especially those with high baseline proteinuria or a diagnosis of focal segmental glomerulosclerosis or minimal change disease) should be closely monitored not only during the acute phases of COVID-19 but also after its resolution.
Background: The acute and long-term effects of severe acute respiratory syndrome coronavirus 2 infection in individuals with GN are still unclear. To address this relevant issue, we created the International Registry of COVID-19 infection in GN. Methods: We collected serial information on kidney-related and -unrelated outcomes from 125 GN patients (63 hospitalized and 62 outpatients) and 83 non-GN hospitalized patients with coronavirus disease 2019 (COVID-19) and a median follow-up period of 6.4 (interquartile range 2.3-9.6) months after diagnosis. We used logistic regression for the analyses of clinical outcomes and linear mixed models for the longitudinal analyses of eGFR. All multiple regression models were adjusted for age, sex, ethnicity, and renin-angiotensin-aldosterone system inhibitor use. Results: After adjustment for pre-COVID-19 eGFR and other confounders, mortality and AKI did not differ between GN patients and controls (adjusted odds ratio for AKI=1.28; 95% confidence interval [CI], 0.46 to 3.60; P=0.64). The main predictor of AKI was pre-COVID-19 eGFR (adjusted odds ratio per 1 SD unit decrease in eGFR=3.04; 95% CI, 1.76 to 5.28; P<0.001). GN patients developing AKI were less likely to recover pre-COVID-19 eGFR compared with controls (adjusted 6-month post-COVID-19 eGFR=0.41; 95% CI, 0.25 to 0.56; times pre-COVID-19 eGFR). Shorter duration of GN diagnosis, higher pre-COVID-19 proteinuria, and diagnosis of focal segmental glomerulosclerosis or minimal change disease were associated with a lower post-COVID-19 eGFR. Conclusions: Pre-COVID-19 eGFR is the main risk factor for AKI regardless of GN diagnosis. However, GN patients are at higher risk of impaired eGFR recovery after COVID-19-associated AKI. These patients (especially those with high baseline proteinuria or a diagnosis of focal segmental glomerulosclerosis or minimal change disease) should be closely monitored not only during the acute phases of COVID-19 but also after its resolution.
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