2021 COVID-19 news: A steady stream of research suggests that many people who have been infected with COVID-19 develop a range of adverse conditions months after their initial infection. An in-depth study of federal health data by medical researchers adds to these concerns, noting that kidney function is significantly reduced in those with the long-term condition known as COVID-19 – even in those who are mildly infected with the virus.
Data collected by researchers at Washington University School of Medicine in St. Louis and the St. Louis Veterans Affairs Health Care System showed that those infected with SARS-CoV-2 had an increased likelihood of developing kidney damage and chronic and advanced kidney disease.
Kidney dysfunction and disease are known as silent killers, often without pain and other symptoms – so much so that the National Kidney Foundation estimates that 90 percent of people with kidney disease are unaware of it. Kidney disease affects 37 million people in the United States and is one of the leading causes of death among Americans.
“Our findings underscore the critical importance of focusing on kidney function and disease when caring for patients with COVID-19,” said senior author Ziyad Al-Aly, MD, PhD, assistant professor of medicine at the University of Washington.” If kidney care is not an integral part of the post-acute care strategy for COVID-19, then we are missing the opportunity to help potentially hundreds of thousands of people who are unaware that their kidney function has declined because of this virus. Not to mention the millions of other Americans who have kidney disease not caused by COVID-19.”
These findings coincide with the surge in COVID-19 infections spurred by the delta variant. More than 38 million people have been diagnosed with the virus since the pandemic began, Al-Aly said, “Based on our research, we believe that 510,000 of these people who have been infected with COVID-19 may have kidney damage or disease.”
The researchers analyzed de-identified medical records in a database maintained by the U.S. Department of Veterans Affairs, the largest integrated health care delivery system in the United States, and used it to create a controlled data set that includes health information on more than 1.7 million healthy and COVID-infected veterans from March 1, 2020, through March 15, 2021. Of these veterans, 89,216 were diagnosed with COVID-19 and survived the acute phase (the first 30 days of the disease).
Most of the COVID-19 patients in the study were men and were nearly 60 years old; however, the researchers also analyzed data including 151,289 women – including 8,817 COVID-19 patients – and adults of all ages. Of the COVID-19 patients, 12,376 (13.9%) required hospitalization, including 4,146 (4.6%) who were admitted to the intensive care unit (ICU).
The risk of decreased kidney function is highest among those admitted to the ICU; however, it is important to note that this risk extends to all patients, even those with less severe COVID-19, and that the early stages of kidney disease can often be treated with medications if caught in time.
“It is critical to detect kidney dysfunction before the problem progresses and becomes more difficult to treat. But kidney problems are silent problems that aren’t detected until someone checks a blood sample. Based on our research, it’s especially important that health care providers do this for people who have had COVID-19. Otherwise, we’re going to miss a lot of people and sadly, we’re going to be dealing with a lot more advanced kidney disease in the future.”
Compared to patients who were not infected, those who contracted the virus but did not need to be hospitalized for it had a 15% higher risk of a major adverse renal event (such as chronic kidney disease), a 30% higher risk of acute kidney injury, and a 215% higher risk of acquiring end-stage renal disease (more than two times higher). The latter occurs when the kidneys can no longer effectively remove waste from the body. In such cases, dialysis or kidney transplantation is required to keep the patient alive.
Patients hospitalized for COVID-19 were at increased risk, and those in the intensive care unit for the virus were at significantly increased risk: seven times the risk of experiencing a major adverse renal event, eight times the risk of acute kidney injury, and 13 times the risk of end-stage renal disease.
“People who were hospitalized or required ICU care for COVID-19 were at the highest risk,” Al-Aly said.” But for those with milder forms of the disease, the risk is not zero. In fact, it’s significant. And we need to remember that we don’t yet know the health effects on the long course of the disease for years to come.”
After the first 30 days of COVID-19 infection, 4,757 (5.3%) patients had a 30% or greater decrease in glomerular filtration rate (GFR), which doctors use to assess kidney function and, if applicable, determine the severity of kidney disease. Glomerular filtration rate is determined by a simple blood test that measures the level of creatinine, a waste product in the blood that is filtered by the kidneys and discarded into the urine.
Researchers found that people with milder cases of COVID-19 had a 1.09-fold risk of an estimated 30 percent or greater drop in GFR. For hospitalized COVID-19 patients not in the intensive care unit, the risk of experiencing a 30 percent or greater drop in estimated GFR was two times greater, while the risk of experiencing a 30 percent or greater drop in estimated GFR was three times greater for patients in the intensive care unit.
Al-Aly explained, “The damage to the kidneys exceeds the diminished function caused by normal aging. The kidneys of a 60-year-old person are not as powerful as those of a 20-year-old person. The decline in kidney function that we observed in these patients is not graceful aging. It is not something normal. It is definitely a disease state. Renal disease is an important aspect of multifaceted long COVID-19, it is an important component of long course COVID-19 symptoms, and it must be considered when caring for patients with long COVID-19.”