Kidney function decline appears to accelerate after COVID-19

Newly published research suggests an association between COVID-19 infection and accelerated kidney function decline, especially among people who had been hospitalized for the infection.

The findings were published on Dec. 26, 2024 in JAMA Network Open.

As background, the authors noted, “Our objective was to investigate whether kidney function decline compared with preexisting estimated glomerular filtration rate (eGFR) trajectories accelerated after COVID-19 infection. Because severe COVID-19 usually presents as a viral pneumonia, we also investigated whether the acceleration in kidney function decline differed from after pneumonia caused by other pathogens.”

The investigators extracted and evaluated data from the Stockholm Creatinine Measurements (SCREAM) Project recorded between February 1, 2018, and January 1, 2022, in Stockholm, Sweden. This included data from all hospitalized and nonhospitalized adults ( >/=18 years) 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.

The data was analyzed between June 2023 and October 2024.

The researchers classified subjects as “hospitalized” if a hospitalization  took place within 28 days of their first recorded positive COVID-19 test result, or if their condition was coded for COVID-19 during a hospitalization.

The COVID-19 cohort was comprised of 134, 565 subjects, 74,819 female (55.6%) with a median age of 51 years.

The pneumonia cohort was comprised 35, 987 subjects, 19,359 female (53.8%); with a median age of 71 years.

The median 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.

The authors noted, “We chose pneumonia as a comparator given that pneumonia is the predominant indication for COVID-19 hospitalization, and we chose a period prior to the pandemic to avoid misclassification.”

They reported accelerated annual eGFR decline in both cohorts, with more decline after a COVID-19 diagnosis (3.4%) than after a pneumonia diagnosis (2.3%).

Decline was worse among subjects hospitalized for COVID-19 (5.4%), and did not vary between hospitalized and non-hospitalized pneumonia subjects,

The authors concluded, “Using routinely collected, comprehensive health care data, we found an accelerated eGFR decline of a larger magnitude among survivors of COVID-19 than survivors of pneumonia due to other infections. We observed a steeper decline in eGFR for patients hospitalized for COVID-19 compared with patients hospitalized for pneumonia. These findings help inform decisions regarding the need to monitor kidney function in survivors of COVID-19 and could have implications for policymakers regarding future health care planning and kidney service provision.