Does COVID-19 Increase the Risk of Subsequent Kidney Diseases More Than Influenza? A Retrospective Cohort Study Using Real-World Data In the United States

Abstract

AbstractBackgroundAlthough case reports and observational studies suggest Coronavirus disease 2019 (COVID-19) increases the risk of kidney diseases, definitive real-world evidence, especially in comparison with influenza, is lacking. Our study aims to assess the association between COVID-19 infections and subsequent kidney diseases, using influenza as a positive control and incorporating a negative control to establish clearer associations.MethodsA large retrospective cohort study with strata matching was conducted using the MarketScan database with records from Jan. 2020 to Dec. 2021. We used the international classification of 10th revision (ICD-10) codes to identify individuals and build three cohorts, (1) COVID-19 group, with index dates as the diagnosis dates of COVID-19; (2) Influenza but no COVID-19 (positive control) group, with index dates as the diagnosis dates of Influenza; and (3) no COVID-19 / Influenza (negative control) group, with randomly assigned index dates between Jan. 2020 to Dec. 2021. The main outcomes were acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD). To evaluate the association between COVID-19 and the new onset of kidney diseases relative to both control groups, we employed multivariable stratified Cox proportional hazards regression analysis.ResultsThe study included 939,241 individuals with COVID-19, 1,878,482 individuals in the negative control group, and 199,071 individuals with influenza. After adjusting for demographics, comorbidities, and medication histories, COVID-19 was significantly associated with increased risks of AKI (adjusted hazards ratio, aHR: 2.74, 2.61-2.87), CKD (aHR: 1.38, 1.32-1.45), and ESRD (aHR, 3.22; 95% CI, 2.67-3.88), while influenza was associated with a modestly increased risk of AKI (aHR: 1.24, 1.11-1.38) and had no impact on CKD (aHR: 1.03, 0.92-1.14), and ESRD (aHR, 0.84; 95% CI, 0.55-1.29). Time-specific analyses indicated that while the HR for AKI declined from 0-180 days to 0-540 days, the HR for CKD and ESRD remained stable, with COVID-19’s risk surpassing influenza’s risk throughout follow-up. Exploratory analysis also found significant impacts of COVID-19 on glomerular diseases (aHR 1.28, 95% CI 1.09-1.50).ConclusionIn this large real-world study, COVID-19 infections were associated with a 2.3-fold risk of developing AKI, a 1.4-fold risk of CKD, and a 4.7-fold risk of ESRD compared to influenza. Greater attention needs to be paid to kidney diseases in individuals after contracting COVID-19 to prevent future adverse health outcomes.