학술논문
Association of COVID-19 Versus COVID-19 Vaccination With Kidney Function and Disease Activity in Primary Glomerular Disease: A Report of the Cure Glomerulonephropathy Study.
Document Type
Academic Journal
Author
Wang CS; Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia. Electronic address: chia-shi.wang@emory.edu.; Glenn DA; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Helmuth M; Arbor Research Collaborative for Health, Ann Arbor, Michigan.; Smith AR; Arbor Research Collaborative for Health, Ann Arbor, Michigan.; Bomback AS; Columbia University, New York, New York.; Canetta PA; Columbia University, New York, New York.; Coppock GM; University of Pennsylvania, Philadelphia, Pennsylvania.; Khalid M; Riley Hospital for Children, School of Medicine, Indiana University, Indianapolis, Indiana.; Tuttle KR; Providence Health and University of Washington, Spokane, Washington.; Bou-Matar R; Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.; Greenbaum LA; Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.; Robinson BM; Arbor Research Collaborative for Health, Ann Arbor, Michigan.; Holzman LB; University of Pennsylvania, Philadelphia, Pennsylvania.; Smoyer WE; Research Institute at Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio.; Rheault MN; Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota.; Gipson D; University of Michigan, Ann Arbor, Michigan.; Mariani LH; University of Michigan, Ann Arbor, Michigan.
Source
Publisher: W.B. Saunders Country of Publication: United States NLM ID: 8110075 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1523-6838 (Electronic) Linking ISSN: 02726386 NLM ISO Abbreviation: Am J Kidney Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Rationale & Objective: Patients with glomerular disease (GN) may be at increased risk of severe COVID-19, yet concerns over vaccines causing disease relapse may lead to vaccine hesitancy. We examined the associations of COVID-19 with longitudinal kidney function and proteinuria and compared these with similar associations with COVID-19 vaccination.
Study Design: Observational cohort study from July 1, 2021, to January 1, 2023.
Setting & Participants: A prospective observational study network of 71 centers from North America and Europe (CureGN) with children and adults with primary minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy.
Exposure: COVID-19 and COVID-19 vaccination.
Outcome: Repeated measure of estimated glomerular filtration rate (eGFR); recurrent time-to-event outcome of GN disease worsening as defined by doubling of the urinary protein-creatinine ratio (UPCR) to at least 1.5g/g or increase in dipstick urine protein by 2 ordinal levels to 3+(300mg/dL) or above.
Analytical Approach: Interrupted time series analysis for eGFR. Prognostic matched sequential stratification recurrent event analysis for GN disease worsening.
Results: Among 2,055 participants, 722 (35%) reported COVID-19 infection; of these, 92 (13%) were hospitalized, and 3 died (<1%). The eGFR slope before COVID-19 infection was-1.40mL/min/1.73m2 (± 0.29 SD); within 6 months after COVID-19 infection, the eGFR slope was-4.26mL/min/1.73m 2 (± 3.02 SD), which was not significantly different (P=0.34). COVID-19 was associated with increased risk of worsening GN disease activity (HR, 1.35 [95% CI, 1.01-1.80]). Vaccination was not associated with a change in eGFR (-1.34mL/min/1.73m 2 ±0.15 SD vs-2.16mL/min/1.73m 2 ±1.74 SD; P=0.6) or subsequent GN disease worsening (HR 1.02 [95% CI, 0.79-1.33]) in this cohort.
Limitations: Infrequent or short follow-up.
Conclusions: Among patients with primary GN, COVID-19 infection was severe for 1 in 8 cases and was associated with subsequent worsening of GN disease activity, as defined by proteinuria. By contrast, vaccination against COVID-19 was not associated with change in disease activity or kidney function decline. These results support COVID-19 vaccination for patients with GN.
Plain-Language Summary: In this cohort study of 2,055 patients with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy, COVID-19 resulted in hospitalization or death for 1 in 8 cases and was associated with a 35% increase in risk for worsening proteinuria. By contrast, vaccination did not appear to adversely affect kidney function or proteinuria. Our data support vaccination for COVID-19 in patients with glomerular disease.
(Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
Study Design: Observational cohort study from July 1, 2021, to January 1, 2023.
Setting & Participants: A prospective observational study network of 71 centers from North America and Europe (CureGN) with children and adults with primary minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy.
Exposure: COVID-19 and COVID-19 vaccination.
Outcome: Repeated measure of estimated glomerular filtration rate (eGFR); recurrent time-to-event outcome of GN disease worsening as defined by doubling of the urinary protein-creatinine ratio (UPCR) to at least 1.5g/g or increase in dipstick urine protein by 2 ordinal levels to 3+(300mg/dL) or above.
Analytical Approach: Interrupted time series analysis for eGFR. Prognostic matched sequential stratification recurrent event analysis for GN disease worsening.
Results: Among 2,055 participants, 722 (35%) reported COVID-19 infection; of these, 92 (13%) were hospitalized, and 3 died (<1%). The eGFR slope before COVID-19 infection was-1.40mL/min/1.73m
Limitations: Infrequent or short follow-up.
Conclusions: Among patients with primary GN, COVID-19 infection was severe for 1 in 8 cases and was associated with subsequent worsening of GN disease activity, as defined by proteinuria. By contrast, vaccination against COVID-19 was not associated with change in disease activity or kidney function decline. These results support COVID-19 vaccination for patients with GN.
Plain-Language Summary: In this cohort study of 2,055 patients with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy, COVID-19 resulted in hospitalization or death for 1 in 8 cases and was associated with a 35% increase in risk for worsening proteinuria. By contrast, vaccination did not appear to adversely affect kidney function or proteinuria. Our data support vaccination for COVID-19 in patients with glomerular disease.
(Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)