Covid survivors more likely to have kidney problems, study finds

Since the start of the pandemic, doctors have found that people who become very ill with Covid-19 often have kidney problems , not just ...


Since the start of the pandemic, doctors have found that people who become very ill with Covid-19 often have kidney problems, not just the lung deficiencies which are hallmarks of the disease.

Now, a large study suggests that kidney problems can last for months after patients have recovered from the initial infection, and may cause severe reduction of kidney function in some patients for life.

The study, published Wednesday in the Journal of the American Society of Nephrology, found that the sicker Covid patients were initially, the more likely they were to experience persistent kidney damage.

But even people with less severe initial infections could be vulnerable.

“You really see, overall, a higher risk of a bunch of important events associated with the kidneys,” said Dr. F. Perry Wilson, nephrologist and associate professor of medicine at Yale, who did not participated in the study. “And what particularly struck me was that these persisted.”

The kidneys play a vital role in the body, removing toxins and excess fluid from the blood, helping to maintain healthy blood pressure, and maintain a balance of electrolytes and other important substances. When the kidneys aren’t working properly or efficiently, fluids build up, leading to swelling, high blood pressure, weakened bones, and other problems.

The heart, lungs, central nervous system and immune system can be weakened. In end-stage kidney disease, dialysis or an organ transplant may be necessary. The condition can be fatal.

The new study, based on patient records from the Department of Veterans Affairs health system, analyzed data from 89,216 people who tested positive for the coronavirus between March 1, 2020 and March 15, 2021, as well as data from 1 637,467 people who were not Covid patients.

Between one and six months after becoming infected, Covid survivors were around 35% more likely than non-Covid patients to have kidney damage or a substantial decrease in kidney function, said Dr Ziyad Al-Aly, head of research and development at the VA St. Louis Health Care System and lead author of the study.

“People who have survived the first 30 days of Covid are at risk of developing kidney disease”, said Dr Al-Aly, a nephrologist and assistant professor of medicine at the Washington University School of Medicine.

Because many people with reduced kidney function do not experience pain or other symptoms, “what is really important is that people realize that the risk is there and that the doctors who look after them. post-Covid patients really pay attention to kidney function and disease, ”he said.

The two groups of patients in the study differed, in that members of one group had all been infected with Covid, and members of the other group could have various other health issues. Experts warned that there were limits to the comparisons.

The researchers tried to minimize the differences with detailed analyzes adjusted for a long list of demographics, pre-existing health conditions, medication use, and whether or not people were in nursing homes.

Another limitation is that the patients in the VA study were largely male and Caucasian, with a median age of 68, so it’s not clear how generalizable the results are.

One of the strengths of the research, experts say, is that it involves more than 1.7 million patients with detailed electronic medical records, making it the largest study to date on kidney problems linked to Covid.

While the results would likely not apply to all Covid patients, they show that for those who took part in the study, “there is a fairly noticeable impact on the kidney health of long-term Covid-19 survivors. term, especially those who were very ill during their acute illness, ”said Dr. C. John Sperati, nephrologist and associate professor of medicine at Johns Hopkins, who was not involved in the study.

Other researchers have found similar patterns, “so this is not the only study suggesting that these events occur after infection with Covid-19,” he added.

He and other experts said that if even a small percentage of the millions of Covid survivors in the United States developed lasting kidney problems, the impact on healthcare would be significant.

To assess kidney function, the research team assessed levels of creatinine, a waste that the kidneys are supposed to remove from the body, as well as a measure of the kidneys’ ability to filter blood, called the estimated glomerular filtration rate. .

Healthy adults gradually lose kidney function over time, about 1% or less per year, starting in their 30s or 40s, Dr. Wilson said. Serious illnesses and infections can lead to deeper or permanent loss of function which can lead to chronic kidney disease or end-stage kidney disease.

The new study found that 4,757 Covid survivors lost at least 30% of their kidney function within a year of infection, Dr Al-Aly said.

This equates to about “30 years of decline in kidney function,” said Dr. Wilson.

Covid patients were 25% more likely to achieve this level of decline than people who had not had the disease, according to the study.

A smaller number of Covid survivors have seen larger declines. But Covid patients were 44% more likely than non-Covid patients to lose at least 40% of kidney function and 62% more likely to lose at least 50%.

End-stage kidney disease, which occurs when at least 85% of kidney function is lost, has been detected in 220 Covid patients, Dr Al-Aly said. Covid survivors were nearly three times more likely to be diagnosed than patients without Covid, according to the study.

Dr Al-Aly and his colleagues also looked at a type of sudden kidney failure called acute kidney injury, which other studies have found in up to half of hospitalized Covid patients. The disease can be cured without causing long-term loss of kidney function.

But the VA study found that months after their infection, 2,812 Covid survivors suffered acute kidney damage, nearly double the rate of non-Covid patients, Dr Al-Aly said.

Dr Wilson said the new data supported the results of a study of 1,612 patients that he and his colleagues conducted that found Covid patients with acute kidney disease had significantly worse kidney function in the months after discharge from the hospital as people with acute kidney injury due to other health problems.

In the new study, researchers did not directly compare Covid survivors with people infected with other viruses, such as the flu, making it difficult to know “are you really sicker than if you were from?” have another bad infection, ”Dr. Sperati said.

In a precedent to study by Dr Al-Aly’s team, however, who looked at many post-Covid health issues, including kidney problems, people hospitalized with Covid-19 were at a significantly higher risk of developing health problems at long term in virtually all medical categories, including cardiovascular, metabolic and gastrointestinal disorders, than those hospitalized with influenza.

Each type of kidney failure measured in the new study was much more common in Covid patients who were sicker to begin with – those in intensive care or who suffered acute kidney failure in hospital.

People who were less sick while in Covid hospital were less likely to have persistent kidney problems, but still much more likely than non-Covid patients.

“The people most at risk are those who really struggled to start,” said Dr Al-Aly. “But really, no one is spared the risk.”

The study also found that even Covid patients who had never needed hospitalization had a slightly higher risk of kidney problems than the general population of VA patients. But the risk seemed so low, Dr Sperati said, that “I don’t know if I would put my hat on” these results.

Dr Wilson noted that some Covid patients who did not need to be hospitalized were nonetheless quite sick, having to stay in bed for days. He said it’s possible these were those who developed long-term kidney dysfunction, rather than people on the lighter end of the Covid spectrum.

Doctors don’t know why Covid can cause kidney damage. The kidneys could be particularly sensitive to flare-ups or activation of the immune system, or the blood clotting problems often seen in Covid patients can disrupt kidney function, experts said.

Dr Sperati said Covid patients in hospital appeared to have a greater need for dialysis, and more protein and blood in their urine, than patients hospitalized for other serious illnesses.

“Covid is probably a bit more of a kidney-toxic virus,” Dr Wilson said. “I think Covid syndrome has long term adverse effects on the kidney. “

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Newsrust - US Top News: Covid survivors more likely to have kidney problems, study finds
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