COVID-19 and kidney disease: A deadly intersection that requires investment in prevention, research

In the months since the novel coronavirus first began infecting individuals in the United States, Americans – health care professionals, researchers, and the public alike – have received a rapid and ever-changing education in the medical science on this devasting virus.

What we initially understood as primarily a respiratory illness has proven itself to be much more.

It’s a virus that can devastate the lungs, but we’ve learned that it can also cause significant injury to other vital organs including the kidneys. Among the most troubling realities is that the virus poses a disproportionate risk to a population of Americans whose health and health care is already so fragile: those living with kidney disease and kidney failure, as well as those living with kidney transplants who rely on immunosuppressant medications which depress the body’s ability to counter infection.

Kidney patients – including those with kidney failure receiving dialysis and transplant recipients – are more at risk from SARS-CoV-2 exposure because of their vulnerable physical conditions, weakened immune systems, and the open settings in which they receive care. Data has shown that people with kidney diseases were 2.5 times more likely to die than other hospitalized patients with COVID-19. And recent data released from the Centers for Medicare and Medicaid Services showed that kidney disease patients undergoing dialysis were hospitalized with COVID-19 at a rate of 1,341 hospitalizations per 100,000 beneficiaries, the highest hospitalization rate among all Medicare beneficiaries. In fact, the first few deaths that occurred in the state of Washington were patients with kidney disease. Kidney disease also disproportionately affects minority populations, a population at higher risk for COVID-19 and COVID-19 associated mortality compared to non-minority populations.

Just as concerning, evidence indicates that people without kidney disease who become infected with COVID-19 may experience acute kidney injury (AKI), the sudden episode of kidney failure or kidney damage. Up to 40 percent of patients with COVID-19 admitted to the Intensive Care Unit experience AKI and require dialysis to stay alive. AKI related to COVID-19 adds another complicated layer to the challenges of caring for people during this pandemic. We simply do not know the long-term impacts of COVID-19 on the kidneys, or whether – or how well – patients with AKI caused by COVID-19 will recover full kidney function.

Addressing the needs of kidney patients affected by COVID-19 falls directly in line with ongoing efforts by the nation’s kidney community. Today, more than ever, we are dedicated to advocating for funding research and investing in innovation to combat anything kidney disease – and COVID-19 – throws our way. If anything else, the present pandemic has underscored the immediate need for federal investment in programs that prevent and slow the progression of kidney disease and spur the development of innovative treatments to support the 37 million Americans living with kidney diseases.

The kidney community is urging Congress to appropriate $100 million in emergency supplemental funding for the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), to answer some of these urgent questions about COVID-19 and kidney health, and $200 million for KidneyX to address the needs of people with kidney diseases for the current COVID-19 crisis and future crises by catalyzing the development of an artificial kidney to allow patients to safely receive care at home and mitigate hemodialysis supply shortages that arise in crises. We also call on Congress to invest in programs that educate, inform and empower Americans with kidney diseases to reduce their exposure to SARS-CoV-2 , to understand how to respond to a potential infection, and to increase general awareness about the risk of kidney diseases.

A recent National Kidney Foundation-Harris Poll Survey on COVID-19 and Kidney Health showed that a majority of Americans support these investments, with 87 percent of respondents stating that they support “the federal government devoting more resources towards the diagnosis, prevention, and treatment of kidney diseases and significantly increasing funding for kidney research at the National Institutes of Health as a result of kidney-related illness resulting from COVID-19.”

Nearly four months into a historic global pandemic, it seems as though we are beginning to overcome the virus – slowing transmissions and learning how to best care for patients. But it’s almost certain that our learning curve will continue, and COVID-19 will present us with more challenges. For the health and wellbeing of all Americans, especially those vulnerable from kidney diseases, it’s crucial that we aggressively pursue research and innovation that gives patients the best chance for survival and a healthy future.

There’s much that we still do not know about COVID-19, but what we do know is this: it’s critical to be prepared.

Anupam Agarwal, MD, FASN, is president of the American Society of Nephrology. Holly Kramer, MD, MPH, is president of the National Kidney Foundation.