Associations of Pre-Pandemic CKD With Acute and Post-Acute COVID-19: The C4R Study.

Authors

Yuni Choi, David R Jacobs, Holly J Kramer, Josef Coresh, Mary Cushman, Alexander P Reiner, Ryan T Demmer, Russell P Tracy, Yifei Sun, Pallavi P Balte, Laura M Raffield, Yuan-I Min, Ramachandran S Vasan, Vanessa Xanthakis, Elizabeth A Regan, Alka M Kanaya, James P Lash, Jason G Umans, Elizabeth C Oelsner

Published in

American journal of kidney diseases : the official journal of the National Kidney Foundation. Jun 26, 2026. Epub Jun 26, 2026.

Abstract

While kidney failure is associated with severe COVID-19, data on early-stage chronic kidney disease (CKD) and its relationship to acute and post-acute COVID-19, as well as post-vaccination antibody responses, are limited. We evaluated pre-pandemic CKD stage in relation to these outcomes.
Prospective cohort.
Adults in nine US population-based studies established since 1971, with pre-pandemic CKD measurements and follow-up for COVID-19 outcomes.
CKD stages (low CKD stage [reference], moderate CKD stage, high CKD stage, and very high CKD stage) defined by creatinine-based eGFR and urinary albumin-to-creatinine ratio.
(i) COVID-19 hospitalization or death (self-report/medical records, 2020‒2023); (ii) RECOVER Long COVID Research Index score ≥11 (LCRI-positivity by questionnaires, 2023‒2024); (iii) post-vaccination anti-Spike 1 (S1) IgG levels (dried blood spots, 2021‒2022).
Cause-specific hazards for severe COVID-19, logistic regression for LCRI-positivity, and generalized additive models for anti-S1 IgG.
Among 26,039 participants, CKD stage was low in 81.7%, moderate in 13.0%, high in 3.6%, and very high in 1.7%. Over a median 550-day follow-up (P25-P75: 314‒636), 734 had severe COVID-19; 12.1% of infected (669/5,527) were classified as LCRI-positive; and 3.1% (82/2,679) were anti-S1 IgG antibody non-reactive. A more severe CKD stage was associated with a greater risk for severe COVID-19: the HR for moderate stage CKD was 1.27 (95% CI, 1.03‒1.56), for high stage CKD, 2.33 (1.77‒3.06), and for very high stage CKD, 2.72 (1.88‒3.92). Higher CKD stages were associated with lower anti-S1 IgG levels: ‒12.00% (95% CI: ‒21.14% to ‒1.78%) for moderate stage CKD, ‒27.03% (95% CI, ‒40.00% to ‒11.25%) for high stage CKD, and ‒48.9% (95% CI, ‒61.60% to ‒32.01%) for very high stage CKD. A higher prevalence of LCRI positivity was observed only among infected individuals with very high stage CKD (OR=2.20; 95% CI: 1.16‒4.18).
Some outcomes were self-reported.
Higher CKD stages were associated with a greater risk for severe COVID-19 and a lower anti-S1 antibody response. No consistent association was observed between CKD stage and LCRI-positivity except in individuals with very high stage CKD.
Chronic kidney disease, kidney dysfunction, SARS-CoV-2 infection, severe COVID-19, Long COVID, anti-S1 IgG antibody, Prospective cohort.

PMID:
42362101
Bibliographic data and abstract were imported from PubMed on 27 Jun 2026.

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