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 1.73m2 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 1.73m20.15 sd vs-2.16ml min 1.73m21.74 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 2055 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.>
