[ad_1]
Since the beginning of the pandemic, doctors have been treating people who have become very ill with Covid-19. often have kidney problemsIt is not just the pulmonary disorders that are the hallmark of the disease.
Now, a big study has shown that kidney problems may persist for months after patients recover from the initial infectionand in some patients, it may lead to a lifelong decline in kidney function.
The study, published Wednesday in the Journal of the American Society of Nephrology, found that sicker Covid patients were more likely to experience permanent kidney damage at baseline.
But even people with less severe initial infections can be vulnerable.
A nephrologist and professor of medicine at Yale, who was not involved in the study, Dr. “You really do see a higher risk for a number of major events associated with the kidneys,” said F. Perry Wilson. “And what was particularly striking to me was that these continued.”
The kidneys play a vital role in the body, removing toxins and excess fluid from the blood, helping to maintain healthy blood pressure, and maintaining the balance of electrolytes and other important substances. When the kidneys are not working properly or efficiently, fluids build up, leading to swelling, high blood pressure, weakened bones, and other problems.
The heart, lungs, central nervous system, and immune system may be impaired. Dialysis or organ transplantation may be necessary in end-stage kidney disease. The condition can be fatal.
The new study, based on records of patients in the Veterans Affairs health system, analyzed data from 89,216 people who tested positive for coronavirus between March 1, 2020 and March 15, 2021, as well as data from 1,637,467 people. Not Covid patients.
Research and development service chief Dr. Ziyad Al-Aly said that one to six months after being infected, Covid survivors are about 35 percent more likely to experience kidney damage or significant declines in kidney function than non-Covid patients. VA St. Louis Health System and senior author of the study.
“People who survive the first 30 days of Covid are at risk of developing kidney disease” A nephrologist and professor of medicine at the Washington University School of Medicine, Dr. Al-Aly said.
Because many people with reduced kidney function don’t experience pain or other symptoms, “what’s really important is that people are aware that the risk is there and that doctors caring for post-Covid patients really pay attention to kidney function and disease,” he said.
The two patient groups in the study differed in that members of one group were all infected with Covid and members of the other group had a variety of other health conditions. Experts warn that there are limitations in comparisons.
Researchers tried to minimize differences with detailed analyzes adjusted for a long list of demographics, pre-existing health conditions, medication use, and whether people were in a nursing home.
Another limitation is that patients in the VA study were largely male and white, with a median age of 68, so it is unclear how generalizable the results are.
Experts said one of the strengths of the study was that it included more than 1.7 million patients with detailed electronic medical records, making it the largest study ever done on COVID-related kidney problems.
While the results likely won’t apply to all Covid-19 patients, for those in the study, “They show a pretty remarkable impact on kidney health in COVID-19 survivors, particularly those who became very ill during their treatment for acute illness,” he said at Johns Hopkins. nephrologist and associate professor of medicine Dr. C. John Sperati was not included in the study.
Other researchers have found similar patterns, “so this is not the only study that shows these events occur after Covid-19 infection,” he added.
He and other experts said that if even a small percentage of millions of Covid survivors in the United States develop permanent kidney problems, the impact on healthcare would be huge.
To assess kidney function, the research team evaluated levels of creatinine, a waste product the kidneys must remove from the body, and a measure of how well the kidneys filter blood, called the estimated glomerular filtration rate.
Dr. Healthy adults gradually lose kidney function over time, about 1 percent or less per year, starting in their 30s or 40s, Wilson said. Serious illnesses and infections can cause deeper or permanent loss of function that can lead to chronic kidney disease or end-stage kidney disease.
Dr. Al-Aly said the new study found that 4,757 Covid survivors lost at least 30 percent of their kidney function in the year after infection.
Dr. That’s roughly equivalent to “30 years of kidney function decline,” Wilson said.
The study found that Covid patients were 25 percent more likely to reach this level of decline than people without the disease.
Fewer Covid victims experienced sharper declines. But Covid patients were 44 percent more likely to lose at least 40 percent of their kidney function and 62 percent more likely to lose at least 50 percent of their kidney function than non-Covid patients.
Dr. Al-Aly said that in 220 Covid patients, end-stage kidney disease, which occurs with the loss of at least 85 percent of kidney function, has been detected. The study found that COVID survivors are nearly three times more likely to be diagnosed than non-COVID patients.
Dr. Al-Aly and colleagues also looked at a type of sudden kidney failure called acute kidney injury, which other studies have found in up to half of hospitalized Covid patients. The condition may improve without causing long-term loss of kidney function.
However, Dr. Al-Aly said the VA study found that 2,812 Covid survivors suffered acute kidney injury months after infection, nearly twice the rate in non-Covid patients.
Dr. Wilson said the new data supports the results of a study he and his colleagues conducted on 1,612 patients that identified Covid patients with acute kidney injury. had significantly worse kidney function Compared to people with acute kidney injury from other medical conditions in the months after leaving hospital.
In the new study, researchers didn’t directly compare Covid survivors with people infected with other viruses such as the flu, making it “harder to know if you’re actually sicker than if you had another bad infection,” Dr. Sperati.
in the previous study However, looking after many post-Covid health issues, including kidney issues, Dr. People hospitalized with Covid-19 were at risk of developing long-term health problems in almost every medical category, including cardiovascular, according to Al-Aly’s team. , metabolic and gastrointestinal conditions than people hospitalized with the flu.
Any type of kidney failure measured in the new study was much more common in Covid patients who were sicker at baseline — in intensive care or in hospital with acute kidney injury.
People who were less sick during their Covid hospitalizations were less likely to experience permanent kidney problems, but were still significantly higher than non-Covid patients.
Dr. “The people at highest risk are the people who were really bad at the beginning,” Al-Aly said. “But really, no one escapes risk.”
The study also found that even Covid patients who never needed hospitalization had a slightly higher risk of kidney problems than the general VA patient population. But the risk seemed so small that Dr. “I don’t know how to hang my hat,” Sperati told these results.
Dr. Wilson noted that some Covid patients who do not need hospitalization are still quite sick and have to stay in bed for days. He said it’s possible that these are people who develop long-term kidney dysfunction, rather than people on the mildest end of the Covid spectrum.
Doctors aren’t sure why Covid can cause kidney damage. Experts said the kidneys may be particularly sensitive to inflammatory fluctuations or immune system activation, or that the blood clotting problems often seen in Covid patients may impair kidney function.
Dr. Sperati said that Kovid patients in the hospital need more dialysis and more protein and blood in their urine than patients hospitalized with other serious illnesses.
Dr. “Covid is probably a virus that’s a little more toxic to the kidneys,” Wilson said. “I think Covid syndrome has some long-term negative effects on the kidney.”
[ad_2]
Source link