Year: 2026
Type: article
Study design: Observational Study
Abstract: RATIONALE & OBJECTIVE: Kidney failure is associated with severe COVID-19, but data on early stage chronic kidney disease (CKD) and its relationship to acute and post-acute COVID-19 as well as postvaccination antibody responses are limited. We evaluated pre-pandemic CKD stage in relation to these outcomes. STUDY DESIGN: Prospective cohort. SETTING & PARTICIPANTS: Adults in 9 US population-based studies established since 1971, with pre-pandemic CKD measurements and follow-up for COVID-19 outcomes. EXPOSURE: CKD stages (low CKD stage [reference], moderate CKD stage, high CKD stage, and very high CKD stage) defined by creatinine-based eGFR and urinary albumin-creatinine ratio. OUTCOME: (1) COVID-19 hospitalization or death (self-report/medical records, 2020-2023); (2) RECOVER Long COVID Research Index score ≥11 (LCRI-positivity by questionnaires, 2023-2024); (3) post-vaccination anti-spike 1 (S1) IgG levels (dried blood spots, 2021‒2022). ANALYTICAL APPROACH: Cause-specific hazards for severe COVID-19, logistic regression for LCRI positivity, and generalized additive models for anti-S1 IgG. RESULTS: Among 26,039 participants, CKD stage was low in 81.7%, moderate in 13.0%, high in 3.6%, and very high in 1.7%. Over a median 550-day follow-up period (IQR, 314-636), 734 had severe COVID-19; 12.1% of infected patients (669 of 5,527) were classified as LCRI positive; and 3.1% (82 of 2,679) were anti-S1 IgG antibody nonreactive. A more severe CKD stage was associated with a greater risk for severe COVID-19: the HR for moderate stage CKD was 1.27 (95% CI, 1.03-1.56), for high stage CKD, 2.33 (1.77-3.06), and for very high stage CKD, 2.72 (1.88-3.92). Higher CKD stages were associated with lower anti-S1 IgG levels: -12.00% (95% CI, -21.14% to -1.78%) for moderate stage CKD, -27.03% (95% CI, -40.00% to -11.25%) for high stage CKD, and -48.9% (95% CI, -61.60% to -32.01%) for very high stage CKD. A higher prevalence of LCRI positivity was observed only among infected individuals with very high stage CKD (odds ratio, 2.20 [95% CI, 1.16-4.18]). LIMITATIONS: Some outcomes were self-reported. CONCLUSIONS: Higher CKD stages were associated with a greater risk for severe COVID-19 and a lower anti-S1 antibody response. No consistent association was observed between CKD stage and LCRI positivity except in individuals with very high stage CKD. PLAIN-LANGUAGE SUMMARY: Chronic kidney disease (CKD) affects approximately 1 in 7 US adults, yet its impact on COVID-19 outcomes, particularly in early stage CKD, remains incompletely understood. We analyzed pre-pandemic CKD stage data from 9 population-based US cohorts to assess their associations with the risk of severe COVID-19, symptom-defined long COVID, and postvaccination anti-spike 1 IgG levels. More advanced stages of CKD had a stronger relationship with severe COVID-19 and a lower anti-S1 antibody response. No consistent association was observed with symptom-defined long COVID, although its prevalence was higher among individuals with very high stage CKD. These findings suggest an altered vaccine-induced immunity and increased susceptibility to both acute and post-acute COVID-19 outcomes among persons with advanced CKD. Adults with advanced CKD may benefit from targeted preventive measures.
Authors: Yuni Choi, David R. Jacobs, Holly J. Kramer, Josef Coresh, Mary Cushman, Alexander P. Reiner, Ryan T. Demmer, Russell P. Tracy, Yifei Sun, Pallavi P. Balte, Laura M. Raffield, Yuan-I Min, Ramachandran S. Vasan, Vanessa Xanthakis, Elizabeth A. Regan, Alka M. Kanaya, James P. Lash, Jason G. Umans, Elizabeth C. Oelsner
Institutions: Columbia University Irving Medical Center, University of Minnesota, Loyola University Chicago, Loyola Medicine, New York University, University of Vermont, University of Washington, Mayo Clinic, Columbia University, University of North Carolina at Chapel Hill, University of Mississippi Medical Center, The University of Texas at San Antonio, Boston University, National Jewish Health, University of California, San Francisco, University of Illinois Chicago, Georgetown-Howard Universities Center for Clinical and Translational Science
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,900
Funders: AstraZeneca, GlaxoSmithKline, Sanofi, Teva Pharmaceutical Industries, Regeneron Pharmaceuticals, Strong, National Institutes of Health, Genentech, National Institute on Aging, National Heart, Lung, and Blood Institute, National Cancer Institute, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: G1069565871, Cardiovascular Disease in Sioux Indians, MESA, VCID and Stroke in a Bi-racial National Cohort, Hispanic Community Health Study, The Strong Heart Study, Phase V, ASSOCIATION OF SLEEP DISORDERS WITH CARDIOVASCULAR HEALTH ACROSS ETHNIC GROUPS, Longitudinal Phenomics and Genetics of Severe Asthma, G1615583090, G164614106, Clinical and Translational Science Institute, Stability of Severe Asthma Phenotypes: Impact of Exacerbations, CVD in American Indians Biomarker lab and Arizona Field Center, G1677275807, Implications and Stability of Clinical and Molecular Phenotypes of Severe Asthma, Wake Forest Clinical and Translational Science Award, Severe Asthma Research Program (SARP)-Washington University, G1901893143, ACTIV Integration of Host-targeting Therapies for COVID-19 Administrative Coordinating Center, G204273421, Transition from Risk Factors to Early HF: Prevalence, Pathogenesis, and Phenomics, G2095942735, G2140171847, G2258234602, MESA, HISPANIC COMMUNITY HEALTH STUDY - FIELD CENTER, G2611541099, MESA, Strong Heart Family Study, SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--EBCT READING, Clinical Coordinating Center for the Severe Asthma Research Program (SARP), G305513510, Cardiovascular Evaluation for the SHS Phase V, Atrial fibrillation burden, vascular disease of the brain and cardiac MRI in MESA, G3191277318, G3240917872, G3352059674, Hispanic Community Health Study, G3581052147, MESA, Epigenome-Wide Association Study of DNA Methylation and Atherosclerosis, G3955673373, The Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites (BP-COG), CVD in American Indians Genetics Center, Airway redox biochemistry as a deteriminant of asthma phenotype during adolescen*, G4289235060, TITLE: MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA), CVD in American Indians Study and Data Management Center and OK Field Center, Hispanic Community Health Study, G4446995582, G4588999532, ARIC Neurocognitive Study (ARIC-NCS) Renewal UNC 4 of 5, G4663197419, G4782433412, OPTION 3. 4/1/2014 - 3/31/2015. MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA) - READING CENTER, NHLBI, MESA, ARIC Neurocognitive Study (ARIC-NCS) Renewal 4 of 5, G5102920066, G5117605154, SUBCLINICAL CARDIOVASCULAR DISEASE STUDY-ULTRASOUND, HISPANIC COMMUNITY HEALTH STUDY - COORDINATING CENTER, CVD in American Indians: Imaging and Cardiovascular Center, AMSA: ALXR/FBR Mediated Signaling in Severe Asthma, A Longitudinal Epigenetic Study of Atherosclerosis, G6072357826, Institute for Clinical and Translational Research, The Framingham Heart Study, MESA, G6525553381, ARIC Neurocognitive Study (ARIC-NCS) Renewal 2 of 5, ARIC Neurocognitive Study (ARIC-NCS), High-Throughput Dried Blood Spot (HT-DBS) Technologies in SARS COV-2 Serology and Vaccinology, MESA, CVD in American Indians The Dakota Field Center, Clinical and Translational Science Award, Mediators of Atherosclerosis in South Asians Living in America, G8388944883, Clinical and Molecular Phenotypes of Severe Asthma, G863538970, G867024095, G8765877990, G8824677906, Combined Cardiopulmonary Failure in COPD: SPIROMICS HF, Cardiovascular Disease in Pima Indians, Precision phenotyping of emphysema in the elderly: the MESA Lung Study, Subclinical Vascular Contributions to Alzheimer's Disease: The Multi-Ethnic Study of Atherosclerosis (MESA) Multisite Study of AD (Renewal), ARIC Neurocognitive Study (ARIC-NCS) Renewal 2023-2028, Airway trees in the Anthropocene: Defining resilient airway trees and identifying the candidate mechanisms and etiologic factors that increase susceptibility to tobacco smoke and air pollution
OpenAlex ID: W7166045185