Abstract: TH-PO1112
Risk Factors for Post-COVID-19 Incident CKD in the National COVID Cohort Collaborative
Session Information
- COVID-19 - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Krichevsky, Spencer, Stony Brook University, Stony Brook, New York, United States
- Koraishy, Farrukh M., Stony Brook University, Stony Brook, New York, United States
- Ellison, David H., Oregon University System, Portland, Oregon, United States
- Liu, Feifan, University of Massachusetts System, Boston, Massachusetts, United States
- Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
- Byrd, J. Brian, University of Michigan, Ann Arbor, Michigan, United States
- Yoo, Yun Jae, Emory University, Atlanta, Georgia, United States
- Saltz, Joel Haskin, Stony Brook University, Stony Brook, New York, United States
- Zhu, Richard L., Johns Hopkins University, Baltimore, Maryland, United States
- Mallipattu, Sandeep K., Stony Brook University, Stony Brook, New York, United States
- Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
- Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
Background
COVID-19 has been associated with accelerated GFR decline in hospitalized patients (pts), but prior studies are limited by cohort sizes, duration of follow-up and geo-specificity. Moreover, characterization of incident CKD in non-hospitalized patients with COVID is lacking.
Methods
Electronic health record data were obtained from 77 health systems in the United States in the National COVID Cohort Collaborative. Adults diagnosed with COVID between Mar 1, 2020, and Oc 1, 2022, and without pre-COVID CKD, were evaluated for incident post-COVID CKD until Dec 31, 2022. CKD was identified via outpatient eGFR measurements or diagnosis (dx) codes. Multivariable (MV) models were applied to analyze risk factors like demographics (age, sex, race/ethnicity), geographical regions (Midwest, Northeast, South, West), hospitalization, AKI, and a reported diagnosis (U09.9) of long-COVID (PASC).
Results
Among 3.7m pts, 76k (2%) had incident post-COVID CKD. Of these pts, 55k (73%) were not assigned a CKD dx code but met requirements for eGFR-based CKD. In MV models, incident CKD was associated with older age, male sex, and Black and Native Hawaiian or Pacific Islander race (compared to White). Compared to pts never hospitalized during follow-up, event rates for incident CKD for pts hospitalized during the COVID dx were significantly higher (11.4 vs 28.7 /1000 patient-years [pt-yrs]). Among hospitalized pts, those with AKI (vs no AKI) had an even higher rate of incident CKD (98.3 vs 21.2 /1000 pt-yr). In MV analyses, when compared to pts never hospitalized, those hospitalized during COVID with AKI had much higher incidence of CKD (hazard ratio [HR] 3.82, p <0.001). The adjusted odds ratios for incident CKD were higher in the West (1.32, p<0.001) and South (1.03, p<0.001) and lower in the Northeast regions (0.94, p<0.001) compared to the Midwest. In a sub-cohort of 1.5mpts evaluated at U09.9-reporting sites, PASC was associated with a moderately higher HR for incident CKD (1.41, p<0.001).
Conclusion
In one of the largest studies on this topic, we observe that incident CKD in pts with COVID was underdiagnosed and influenced by geographical region, hospitalization and AKI. Pts with PASC had higher rates of CKD compared to those without.
Funding
- NIDDK Support