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A recent study found that COVID-19 hospitalization for patients with CKD increased the risk for poor long-term adverse kidney and cardiovascular outcomes.

For patients with chronic kidney disease (CKD), hospitalization for treatment of COVID-19 infection increases risk for major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and CKD progression, according to a study published in Scientific Reports.

“Patients with chronic kidney disease (CKD) are at significantly higher risk of adverse outcomes after COVID-19,” wrote corresponding author Tim Q. Duong, PhD, of Albert Einstein College of Medicine and Montefiore Medical Center, and study coauthors. “The objective of our study was to assess the long-term outcomes of patients with CKD up to 24 months after COVID-19 compared to patients with CKD without a diagnosis of COVID-19. Specifically, we evaluated the risk of CKD progression to a more advanced stage and the risk of major adverse kidney events (MAKE) and major adverse cardiovascular events (MACE).”

Cohort Characteristics

The retrospective analysis included 7,001 patients with CKD from hospitals and outpatient clinics of the Montefiore Health System in the Bronx, New York, during the period from March 11, 2020, to July 1, 2023. Among them, 834 had COVID-19 and 6,167 did not. Patients with preexisting end-stage kidney disease requiring dialysis or with a previous estimated glomerular filtration rate (eGFR) below 15 mL/min/1.73 m² at baseline were excluded.

Higher Incidence of MAKE & MACE

The cohort hospitalized for COVID‑19 experienced significantly higher incidence of MAKE than both the nonhospitalized cohort with COVID‑19 and the uninfected cohort (P<0.001); the nonhospitalized cohort with COVID‑19 also showed elevated MAKE versus the uninfected cohort (P<0.001), according to the study. Adjusted hazard ratios (aHRs) for hospitalized individuals were 2.94 at 6 months, 2.24 at 12 months, and 2.03 at 24 months; nonhospitalized patients had aHRs of 1.90, 1.81, and 1.53, respectively, with risk attenuating over time.

Furthermore, the researchers reported that the cohort hospitalized for COVID-19 had a higher incidence of MACE compared with the nonhospitalized cohort with COVID-19 (P<0.001) and the cohort without COVID-19 (P<0.001). They found no difference in MACE between the nonhospitalized cohort with COVID-19 and the cohort without COVID-19 (P=0.47).

Accelerated CKD Progression

The findings showed that the cohort hospitalized for COVID‑19, but not the nonhospitalized cohort with COVID-19, were at higher risk for CKD progression compared with the cohort without COVID-19. After adjusting for acute kidney injury (AKI) and comorbidities, HRs were 1.62 at 12 months and 1.76 at 24 months.

“The risk of progression to a more advanced CKD stage among patients hospitalized with COVID‑19 was larger or comparable with other CKD risk factors, underscoring the relatively high risk COVID‑19 had on CKD progression even after adjustment for AKI,” observed the authors.

Comprehensive Care & Proactive Prevention

“Patients with underlying CKD who are hospitalized for COVID-19 are at increased risk of poor long-term adverse kidney and cardiovascular outcomes. These findings highlight the importance of comprehensive follow‑up care to slow CKD progression and prevent cardiovascular events in this high‑risk subgroup,” the authors concluded, advocating vigilant renal and cardiovascular monitoring alongside proactive COVID‑19 prevention.