CKD and Rapid Kidney Function Decline During the COVID-19 Pandemic

ABSTRACT

The impact of COVID-19 infection and the indirect effects of the pandemic on the trajectory of CKD is unknown. We performed a retrospective study using de-identified administrative claims data for Medicare Advantage enrollees with CKD Stages G3-4 in 2018-2021. Rapid kidney function decline (RFKD) was defined as a decrease in eGFR of >5ml/min/1.73m2 per year. RFKD was compared for the overall cohort during the pre-pandemic period (Jan 1, 2018 to Feb 29, 2020) to RFKD for the pandemic period (March 1, 2020 to August 31, 2021), and comparatively between enrollees with and without a diagnosed COVID-19 infection. We also evaluated factors independently associated with RKFD. Of 90,734 enrollees with available data, mean age was 75 years, 59% were males, 70% were White;62%, 30%, 8% had CKD G3a, 3b, and 4, respectively. RKFD was observed in 20.4% of enrollees in the pre-pandemic period and in 26.8% during the pandemic. Overall, COVID infection was diagnosed in 8.7% of enrollees. RKFD was observed in 28.2% of those with a COVID-19 diagnosis and 25.1% of those without (p value < 0.05). Factors associated with increased odds of RKFD in the pandemic included Black or Hispanic race/ethnicity, RKFD in the pre-pandemic period, and documented COVID infection;advancing CKD stage was inversely associated with RRFD (Figure). The COVID-19 pandemic resulted in more than a quarter of the population experiencing rapid kidney function decline for individuals with CKD, irrespective of COVID-19 infection. The downstream impact of pandemic-related eGFR decline on health outcomes, such as cardiovascular disease, kidney failure or mortality, requires further study. (Figure Presented)