Kidney Function Decline After COVID-19 Infection
JAMA Network Open, vol. 7, pp. e2450014
Abstract
Importance: COVID-19 infection has been associated with acute kidney injury. However, its possible association with long-term kidney function is not well understood. Objective: To investigate whether kidney function decline accelerated after COVID-19 compared with after other respiratory tract infections. Design, Setting, and Participants: This cohort study used linked data from the Stockholm Creatinine Measurements (SCREAM) Project between February 1, 2018, and January 1, 2022, in Stockholm, Sweden. All hospitalized and nonhospitalized adults in the database with at least 1 estimated glomerular filtration rate (eGFR) measurement in the 2 years prior to a COVID-19 positive test result or pneumonia diagnosis were selected. Statistical analyses were conducted between June 2023 and October 2024. Exposure: COVID-19 and pneumonia (including influenza). Main Outcomes and Measures: Mean annual change in eGFR after COVID-19 and after pneumonia was calculated with a linear regression model. Results: The COVID-19 cohort comprised 134 565 individuals (74 819 females [55.6%]; median [IQR] age, 51 [37-64] years). The pneumonia cohort consisted of 35 987 individuals (19 359 females [53.8%]; median [IQR] age, 71 [56-81] years). The median (IQR) baseline eGFR was 94 (79-107) mL/min/1.73m2 for the COVID-19 cohort and 79 (61-92) mL/min/1.73m2 for the pneumonia cohort. After adjustment for covariates, both infections demonstrated accelerated annual eGFR decline, with greater magnitude of decline after COVID-19 (3.4% [95% CI, 3.2%-3.5%] after COVID-19; 2.3% [95% CI, 2.1%-2.5%] after pneumonia). This decline was more severe among individuals hospitalized for COVID-19 (5.4%; 95% CI, 5.2%-5.6%) but remained similar among those hospitalized for pneumonia. Conclusions and Relevance: This cohort study found an association between COVID-19 and accelerated decline in kidney function, particularly after hospitalization, compared with pneumonia. People who were hospitalized for COVID-19 should receive closer monitoring of kidney function to ensure early diagnosis and optimized management of chronic kidney disease to effectively prevent complications and further decline.
Authors 14
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Viyaasan Mahalingasivam corresponding
National Health Service · Barts Health NHS Trust · Karolinska Institutet · London School of Hygiene & Tropical Medicine
Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Department of Nephrology and Transplantation, Barts Health National Health Service Trust, London, United Kingdom
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Inserm · Université Paris-Saclay · Karolinska Institutet
Affiliation as printed
Department of Clinical Epidemiology, Institut National de la Santé et de la Recherche Médicale U1018, Paris-Saclay University, Villejuif, France
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Karolinska Institutet · Instituto Nacional de Pediatria
Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Translational Research Center, Instituto Nacional de Pediatria, Mexico City, Mexico
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Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Leiden University Medical Center · Karolinska Institutet
Affiliation as printed
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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London School of Hygiene & Tropical Medicine · Bristol Water (United Kingdom)
Affiliation as printed
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
UK Kidney Association, Bristol, United Kingdom
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Linköping University · Karolinska Institutet
Affiliation as printed
Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
Unit of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Karolinska University Hospital · Karolinska Institutet
Affiliation as printed
Unit of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
Unit of Renal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
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London School of Hygiene & Tropical Medicine · University of Glasgow
Affiliation as printed
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
Public Health, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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London School of Hygiene & Tropical Medicine
Affiliation as printed
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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London School of Hygiene & Tropical Medicine
Affiliation as printed
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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