ABSTRACT
Background: The ongoing COVID19 pandemic continues to challenge healthcare systems. While COVID19 disease is associated with Acute Kidney Injury and collapsing glomerulonephritis, little is known about the potential kidney manifestations of PASC (Post-Acute Sequelae of COVID19). In this study we used TrinetX, a large health research network that aggregates data from multiple centers in the United States to analyze the effects of COVID19 on chronic kidney disease (CKD) manifestations of PASC. Method(s): We searched TrinetX for patients > 18 years old with a documented SARSCOV-2 PCR test and classified them into 2 cohorts: C19+ve (with a [+] molecular test for SARS-COV-2 or a clinical diagnosis of COVID19 disease) and C19-ve (absence of such findings). We excluded patients who had received any COVID19 vaccine. We collected demographics, comorbidities, diagnoses for up to two years after any COVID19 PCR test (index event). A 1:1 propensity score matching (PSM) using the nearest neighbor method was used to balance the 2 cohorts on age, gender, Hispanic ethnicity, black race, hypertension, diabetes, heart failure and atherosclerosis. Patients with a kidney specific diagnosis prior to their COVID19 PCR test were excluded. Result(s): We identified 2,780,780 C19+ve and 6,757,849 C19-ve patients. After PSM each group contained 2,775,418 subjects. Mean age was 40.2+/-23.1, females were 54.7%, blacks were 15.8% & 12.3% were Hispanic or Latinos. COVID19 diagnosis was a strong risk factor for CKD (Relative Risk, RR 2.474, p<0.001), nephritic, nephrotic syndrome and glomerular disorders. Conclusion(s): COVID19 disease is a major risk factor for incident CKD, nephrotic and nephritic syndrome. These findings should be confirmed in prospective studies. Whether these sequalae represent persistence of the kidney tropic SARS-COV-2 virus, vascular damage from the acute infection or a manifestation of autoimmunity can only be established through targeted mechanistic studies.
ABSTRACT
Background: COVID19 disease has emerged as a major risk factor of chronic health conditions, i.e. PostAcute Sequelae of COVID19 (PASC). With the emergence of more transmissible variants, the global human population will eventually be exposed to the spike protein of SARS-COV-2 either through natural infection or vaccination. It remains unknown whether vaccination may affect the kidney manifestations of PASC. Method(s): We searched TrinetX, a large health research network that aggregates data from multiple centers in the United States to analyze the effects of vaccination on CKD manifestations of PASC. We classified patients as C19+ve (with a [+] molecular test for SARS-COV-2 or a clinical diagnosis of COVID19 disease) and Vax7+ve if they had at least one dose of any COVID19 vaccine and did not have a breakthrough infection. We collected demographics, comorbidities, diagnoses for up to 2 years after any COVID19 PCR test (index event). A 1:1 propensity score matching (PSM) using the nearest neighbor method was used to balance the two cohorts on age, gender, Hispanic ethnicity, black race, hypertension, diabetes, heart failure and atherosclerosis. Patients with a kidney specific diagnosis prior to their COVID19 PCR test were excluded. Result(s): We identified 2,780,576 C19+ve and 735,966 Vax+ve patients. After PSM each group contained 736,034 subjects. Mean age was 51.5+/-21.4, females were 58.8%, blacks were 14.9% & 9.9% were Hispanic or Latinos. COVID19 vaccination was associated with reduced risk of incident CKD, unspecified kidney failure and the nephritic syndrome, but did not reduce the risk of the nephrotic syndrome or glomerulonephritis relative to COVID19 disease. Conclusion(s): Vaccination may reduce the risk of CKD associated with PASC. If confirmed in a prospective study, our findings can expand the known benefits of vaccination on the acute disease to PASC manifestations, potentially improving the uptake of the COVID19 vaccines by the population.