Chronic kidney disease: the most prevalent risk factor and the risk factor that increases most the risk for lethal COVID-19

Chronic kidney disease (CKD) is defined as an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2 or evidence of kidney damage, such as albuminuria greater than 30 mg/g creatinuria, which persists more than 3 months. These cut-off points mark an increased risk of progression to the need for kidney replacement therapy and of the risk of premature death. Coronavirus disease-2019 (COVID-19) is no exception. The Global Burden of Disease collaboration identified CKD as the global most prevalent risk factor for severe COVID-19. The OpenSAFELY project analyzed the factors associated with death from COVID-19 in 17 million persons. Dialysis (adjusted hazard ratio [aHR] 3.69), organ transplantation (aHR 3.53) and CKD not on dialysis (aHR 2.52 for patients with eGFR <30 ml/min/1.73 m2) represent three of the four comorbidities associated with the highest risk of mortality from COVID-19. The risk associated with CKD is greater than the risk associated with diabetes mellitus (range aHR 1.31-1.95, depending on glycemic control) or chronic heart disease (aHR 1.17), whereas hypertension is not an independent risk factor for death from COVID-19 (aHR 0.89). The high prevalence of CKD, combined with the high risk of mortality from COVID-19 in CKD, requires urgent action to protect CKD patients from COVID-19 by offering the opportunity to participate in clinical trials of vaccines and treatments for COVID-19.