Impact of COVID-19 on chronic kidney disease progression: a prospective cohort study

Abstract

Introduction. Chronic kidney disease and COVID-19 are both associated with significant Introduction. Chronic kidney disease and COVID-19 are both associated with significant morbidity. Patients with chronic kidney disease are at risk for severe COVID-19, and SARS-CoV-2 infection may accelerate CKD progression. This study aimed to compare renal outcomes in CKD patients with and without prior COVID-19 and to identify predictors of progression. Materials and methods. We conducted a prospective cohort study of 280 pre-dialysis CKD patients (stages G2–G5), followed for 12 months. Of these, 140 had a history of COVID-19 (post-COVID group), and 140 had no such history (control group). Baseline assessments included renal function (eGFR, creatinine, urea), inflammatory markers (CRP, ferritin, LDH), hematologic indices (hemoglobin, leukocytes, platelets), and SF-36 quality of life scores. CKD progression was defined as a ≥30% eGFR decline or the initiation of dialysis. Analyses included group comparisons, correlations, logistic regression, and ROC curves. Results. Baseline characteristics and mean eGFR (~60 mL/min/1.73 m²) were similar across groups. CRP and ferritin levels were elevated in both groups without significant differences. Post-COVID patients reported lower vitality and higher social functioning on SF-36 (both p < 0.001). After 12 months, the post-COVID group showed greater eGFR decline (–3.1 vs –1.2 mL/min) and a higher progression rate (28% vs 15%, p < 0.01). Multivariable analysis identified prior COVID-19 (adjusted OR ≈2.3, 95% CI: 1.3–4.0) and low baseline hemoglobin as independent predictors of progression; CRP and ferritin were not predictive. LDH showed a modest association. Hemoglobin alone predicted progression with an AUC of 0.78; the combined model (COVID status + hemoglobin) yielded an AUC of 0.85. Conclusions. CKD patients with prior COVID-19 experienced a faster renal function decline over one year than those without COVID-19. Persistent anemia and elevated LDH were also associated with increased progression risk. These findings emphasize the importance of post-COVID renal monitoring and early intervention in CKD patients to prevent deterioration.