COVID-19 Infection Increases Risk of Advanced CKD, Long-Term Renal Dysfunction

New research is shedding light on the impact of COVID-19 on the development of advanced chronic kidney disease (CKD) in individuals without pre-existing acute kidney injury (AKI).1

Leveraging data from the TriNetX Healthcare Commercial Organizations (HCOs) database for nearly 300,000 adult patients diagnosed with COVID-19 or influenza, the matched cohort study found individuals with COVID-19 had an increased risk of new-onset advanced CKD and long-term renal dysfunction than those with influenza.1

“Evidence has established that patients who develop AKI during acute COVID-19 face an increased risk of subsequent CKD,” Kuo-Chuan Hung, of the College of Medicine at National Sun Yat-sen University in Taiwan, and colleagues wrote.1 “However, an important knowledge gap remains regarding the long-term renal consequences in COVID-19 survivors who did not experience AKI during their initial infection.”

While COVID-19 was initially recognized for its respiratory manifestations, emerging evidence indicates SARS-CoV-2 infection can lead to long-term complications affecting multiple organ systems, including the kidneys.2

To assess the association between COVID-19 and the subsequent risk of advanced CKD, investigators conducted a retrospective cohort study using data from the TriNetX HCOs database, a global federated network that includes electronic health records from 133 healthcare organizations predominantly located in the US. For inclusion, patients were required to be ≥ 18 years of age with ≥ 2 HCO visits between 2022 and 2023.1

From this population, investigators identified 2 groups of patients: those diagnosed with COVID-19 for the first time, the COVID-19 group, and those diagnosed with influenza for the first time, the influenza group. To prevent confounding from dual infections, investigators excluded patients in the COVID-19 group if they had an influenza diagnosis within 1 year before or after their COVID-19 diagnosis, patients in the influenza group if they had a COVID-19 diagnosis within 1 year before or after their influenza diagnosis, as well as patients with any history of advanced renal dysfunction in the year prior to their COVID-19 or influenza diagnosis.1

In total, investigators identified 636,264 eligible patients with COVID-19 and 141,737 eligible patients with influenza. To minimize selection bias and confounding factors, they performed 1:1 propensity score-matching between the groups using logistic regression, accounting for age, sex, race, and comorbidities and yielding final analytical cohorts of 141,587 patients in each group.1

The primary outcome was the incidence of advanced CKD occurring between 1 and 12 months after COVID-19 or influenza infection. Secondary outcomes included the risk of AKI and single estimated glomerular filtration rate (eGFR) measurement < 60 mL/min/1.73 m².1

During the first 6 months of follow-up, investigators noted patients in the COVID-19 group had higher rates of AKI (0.25% vs 0.08%; Hazard ratio [HR], 3.16; 95% CI, 2.57–3.88; P <.0001); advanced CKD (0.14% vs 0.07%; HR, 2.25; 95% CI, 1.76–2.87; P <.0001); and reduced eGFR (0.68% vs 0.22%; HR, 3.32; 95% CI, 2.92–3.78; P <.0001) than those in the influenza group.1

Further analysis revealed the disparity in renal function observed at 6 months persisted through 12 months, with all differences remaining statistically significant (P <.0001).1

In a subgroup analysis stratified by sex, both females and males showed significantly greater incidence rates of AKI, advanced CKD, and reduced eGFR in the COVID-19 group than in the influenza group during the 12-month follow-up period (all P <.0001).1

Additional analysis of age-stratified outcomes at 12 months revealed that while patients > 45 years of age in the COVID-19 cohort showed more pronounced differences in all kidney outcomes, the younger cohort ≤ 45 years of age did not demonstrate an increased risk of advanced CKD at the 12-month follow-up (P = .2311).1

In a matched comparison of COVID-19 patients with and without early hospitalization, those who were hospitalized had higher risks for AKI (HR, 2.43; 95% CI, 2.14–2.76; P <.0001) and eGFR < 60 mL/min/1.73 m² (HR, 1.56; 95% CI, 1.43–1.69; P <.0001), but not advanced CKD (HR, 1.05; 95% CI, 0.89–1.24; P = .591).1

“Future research should focus on developing targeted interventions for these high-risk populations and understanding the underlying mechanisms driving different types of kidney dysfunction,” investigators concluded.1

References

1. Chen IW, Chang LC, Ho CN, et al. Association between COVID-19 and the development of chronic kidney disease in patients without initial acute kidney injury. Sci Rep. https://doi.org/10.1038/s41598-025-96032-4

2. Johns Hopkins Medicine. Coronavirus: Kidney Damage Caused by COVID-19. March 1, 2022. Accessed March 31, 2025. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-kidney-damage-caused-by-covid19