Managing Chronic Kidney Disease in the Time of COVID-19

COVID-19 is considered a respiratory illness, but it’s also been shown to take a toll on the kidneys.

Some otherwise healthy adults with COVID-19 develop sudden loss of kidney function, known as acute kidney injury. Dialysis may be necessary in severe cases, but this type of kidney damage can sometimes be reversed.

Exactly why severe cases of COVID-19 affect the kidneys isn’t yet clear, but contributing factors may include:

• acute tubular necrosis with septic shock
• microinflammation
• increased blood clotting that “clogs” the kidneys
• low oxygen levels
• COVID-19 directly infecting the kidney

If you have CKD, developing COVID-19 can quickly overwhelm your kidneys.

It appears that more advanced existing kidney disease is associated with worse COVID-19 outcomes. A recent study found that people with COVID-19 and end stage renal disease (ESRD) were 11 times more likely to be hospitalized than people who didn’t have kidney disease.

Because COVID-19 is a relatively new disease, large studies in people with CKD and COVID-19 are lacking at this time.

Having CKD itself doesn’t necessarily put you at higher risk of contracting the virus. However, you may be at greater risk if your immune system is weakened due to:

• antirejection medicines following a kidney transplant
• need for dialysis
• ESRD

If you do get the virus that causes COVID-19, you’re at greater risk of severe illness and outcomes, such as a further decline in kidney function. This risk may be even higher if you have other chronic conditions such as diabetes, heart disease, or lung disease.

People with CKD are at higher risk of developing a severe case of COVID-19. So it’s important to take all of the necessary precautions to prevent infection.

Here are some ways you can limit your chances of developing COVID-19:

• Avoid crowds and keep 6 feet of distance between yourself and those outside your household.
• Wear a high quality mask with a tight fit, or double mask in public.
• Wash your hands thoroughly and often with soap and water.
• Carry hand sanitizer with you when you leave the house and use it after touching items used by multiple people, such as gas pump handles or credit card machines.
• Avoid touching your eyes, nose, and mouth unless you’ve just washed your hands.
• Clean and disinfect things you touch often, such as door handles, your phone case, and the steering wheel of the car.

In addition to everyday tasks, you may be wondering how to safely navigate getting the CKD care you need. There may be many items or services you require on a regular basis to manage your condition.

Here some tips on how to keep up with your CKD treatment plan and prevent an infection:

Stock up

When possible, try to stock up on kidney-friendly foods, as well as other staple grocery items and household supplies. Make a list of your regular needs and arrange for scheduled deliveries if possible.

It’s a good idea to keep a 30-day supply of medication on hand. You can also set up home delivery of a 90-day supply of your medications, which many insurance companies offer.

Dialysis

If you’re on dialysis, it’s extremely important to continue your scheduled treatments. Having your blood filtered by a dialysis machine helps keep your immune system strong. It can also be dangerous to skip treatments.

All dialysis clinics should be taking precautions to help prevent the spread of COVID-19. You can also practice good handwashing hygiene, physical distancing, and wearing a mask once you leave your house — and throughout your appointment — to lower your risk of infection.

Antirejection medications

Antirejection drugs are necessary to prevent organ rejection after a transplant. However, they also suppress the immune system and make it harder to fight infection. These are lifesaving medications, so you must continue to take them exactly as prescribed.

Talk with a doctor or healthcare professional if you have any specific concerns about the medications you’re taking and the risks versus benefits.

Stay focused on your overall health and well-being

It can be exhausting to manage a chronic illness. It can be a great help to build a support team to help you stay on track with healthy habits and proper treatment.

Having support in place can help you stay focused on your kidney health and keep up with managing any other underlying conditions you may have.

Diabetes, hypertension, and cardiovascular disease are also known risk factors for developing severe cases of COVID-19.

Here are a few more ways to keep your health on track:

• Try to keep scheduled appointments and request virtual or telehealth appointments whenever possible.
• Eat a healthy diet, do some form of daily exercise, and try to get an adequate amount of restful sleep.
• Follow any recommendations from your doctor to prevent kidney failure.

Talk with a doctor or healthcare professional if you have any concerns about COVID-19 and upcoming surgeries or other procedures. Symptoms of COVID-19 can escalate rapidly, so report new or worsening symptoms, even if they don’t seem serious.

Treatment of COVID-19 depends on the severity of your symptoms, other coexisting conditions, and what organs are affected. You may need a variety of supportive treatments and medications.

If you’re hospitalized for COVID-19, treatment may include:

• supplemental oxygen or mechanical respiratory support
• infection control
• corticosteroids
• blood thinners
• antiviral drug (remdesivir)
• convalescent plasma
• dialysis

When the kidneys aren’t properly functioning, it can affect other organs, such as the heart, lungs, and liver.

A recent study showed that CKD is a key risk factor in COVID-19 mortality, in which the level of kidney dysfunction plays a role.

Even without preexisting kidney disease, new kidney problems are common in people who become critically ill with COVID-19. A multicenter retrospective study found that:

• People who are critically ill with COVID-19 and have any kidney impairment have high mortality rates.
• Mortality is similar in those with new acute kidney impairment and those with preexisting CKD, except for those who’ve had kidney transplants.
• Mortality is higher in people with more serious stages of kidney damage.
• A significant number of patients who survive COVID-19 need renal replacement therapy after leaving the intensive care unit.
• Mortality rates for people with all stages of CKD, new kidney impairment, and ESRD were about the same but were double that of patients who had no kidney impairment.

If you have a mild case of COVID-19, symptoms may not last beyond a few days. The length of a hospital stay depends on the severity of your illness.

A doctor can give you a sense of your overall outlook based on how your kidneys are functioning and if there is any other permanent organ damage.

If you’ve had COVID-19 and CKD, you’ll likely receive ongoing monitoring and treatment.

CKD is a condition in which the kidneys become progressively and irreversibly damaged over time. It can develop due to conditions such as diabetes, high blood pressure, and heart disease.

Your kidneys serve several functions. They balance salts and minerals, help control blood pressure, and make red blood cells. They also filter excess fluid and waste from the blood, sending it to the bladder to exit in your urine.

When the kidneys are damaged and not working properly, waste products build up in the body, which can affect other organs.

The kidneys can lose quite a bit of function and still do an adequate job. But if kidney function gets down to 15 percent or less, you’re considered to be in kidney failure. At this point, you’ll likely need dialysis or a kidney transplant.

Worsening kidney disease can lead to other health problems such as anemia, heart disease, and stroke. However, not everyone with CKD will progress to the point of kidney failure.

The Centers for Disease Control and Prevention (CDC) estimates that about 37 million adults in the United States have CKD, although many don’t know it.

CKD increases the risk of severe illness and hospitalization if you develop COVID-19. Your best defense is to continue with all of your CKD treatments and take precautions to prevent infection.

Stay informed and speak with a doctor about ways to safely navigate CKD treatment and how to get a COVID-19 vaccine.