Evidence map›Paper›PMID 42362101›Full record

ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2026

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

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 and 9 more

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Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

The trial behind it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

19 authors.

Yuni ChoiDivision of General Medicine, Columbia University Medical Center, New York, New York.
David R JacobsDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Holly J KramerDivision of Nephrology and Hypertension, Department of Medicine, Departments of Public Health Sciences and Medicine, Loyola University-Chicago, Maywood, Illinois.
Josef CoreshDepartments of Medicine and Public Health, Grossman School of Medicine, New York University, New York, New York.
Mary CushmanDepartment of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont.
Alexander P ReinerDepartment of Epidemiology, University of Washington, Seattle, Washington.
Ryan T DemmerDivision of Epidemiology, Department of Quantitative Health Sciences, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota.
Russell P TracyDepartment of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont.
Yifei SunDepartment of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
Pallavi P BalteDivision of General Medicine, Columbia University Medical Center, New York, New York.
Laura M RaffieldDepartment of Genetics, University of North Carolina, Chapel Hill, North Carolina.
Yuan-I MinDepartment of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
Ramachandran S VasanDepartment of Medicine, School of Public Health-San Antonio, University of Texas, San Antonio, Texas.
Vanessa XanthakisDepartments of Medicine and Biostatistics, Schools of Medicine and Public Health, Boston University, Boston, Massachusetts.
Elizabeth A ReganDivision of Rheumatology, Department of Medicine, National Jewish Health, Denver, Colorado.
Alka M KanayaDivision of General Internal Medicine, University of California, San Francisco, California.
James P LashDepartment of Medicine, Division of Nephrology, University of Illinois-Chicago, Chicago, Illinois.
Jason G UmansGeorgetown-Howard Universities Center for Clinical and Translational Science and MedStar Health Research Institute, Washington, DC.
Elizabeth C OelsnerDivision of General Medicine, Columbia University Medical Center, New York, New York. Electronic address: eco7@cumc.columbia.edu.

Funding

ACTIV Integration of Host-targeting Therapies for COVID-19 Administrative Coordinating CenterOT2HL156812 · NHLBI · RESEARCH TRIANGLE INSTITUTE · PI NOLEN, TRACY L, THOMAS, SONIA M · 2020 to 2024
$1270.7M
UCSF CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTEUL1RR024131 · NCRR · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI JOHNSTON, S. CLAIBORNE · 2006 to 2011
$111.2M
VCID and Stroke in a Bi-racial National CohortU01NS041588 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI CUSHMAN, MARY, HOWARD, GEORGE · 2002 to 2022
$96.0M
ARIC Neurocognitive Study (ARIC-NCS) Renewal 2023-2028U01HL096812 · NHLBI · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI JOSEF CORESH, THOMAS H MOSLEY · 2010 to 2026
$65.7M
Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1M
Subclinical Vascular Contributions to Alzheimer's Disease: The Multi-Ethnic Study of Atherosclerosis (MESA) Multisite Study of AD (Renewal)R01AG058969 · NIA · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI Timothy M. Hughes, YONGMEI LIU · 2018 to 2026
$33.4M
Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
FRAMINGHAM HEART STUDY - YEAR 5 EXAM75N92019D00031 · NHLBI · BOSTON UNIVERSITY MEDICAL CAMPUS · PI RAMACHANDRAN, VASAN · 2019 to 2024
$29.8M
Clinical and Translational Science AwardUL1TR000040 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2012 to 2015
$26.2M
The Strong Heart Study, Phase VU01HL041654 · NHLBI · UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR · PI LEE, ELISA TAN · 1988 to 2013
$19.2M
Pulmonary microvascular perfusion in the Multi-Ethnic Study of AtherosclerosisR01HL077612 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI R Graham BARR · 2004 to 2026
$18.8M
Pulmonary Vascular Changes in Early Chronic Obstructive Pulmonary Disease (COPD)R01HL093081 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI R Graham BARR · 2008 to 2026
$17.2M
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6 · The paper itself

Abstract

RATIONALE &

objectiveKidney failure is associated with severe COVID-19, but data on early stage chronic kidney disease (CKD) and its relationship to acute and post-acute COVID-19 as well as postvaccination antibody responses are limited. We evaluated pre-pandemic CKD stage in relation to these outcomes. STUDY

designProspective cohort. SETTING &

participantsAdults in 9 US population-based studies established since 1971, with pre-pandemic CKD measurements and follow-up for COVID-19 outcomes. EXPOSURE: 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-creatinine ratio. OUTCOME: (1) COVID-19 hospitalization or death (self-report/medical records, 2020-2023); (2) RECOVER Long COVID Research Index score ≥11 (LCRI-positivity by questionnaires, 2023-2024); (3) post-vaccination anti-spike 1 (S1) IgG levels (dried blood spots, 2021‒2022). ANALYTICAL APPROACH: Cause-specific hazards for severe COVID-19, logistic regression for LCRI positivity, and generalized additive models for anti-S1 IgG.

resultsAmong 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 period (IQR, 314-636), 734 had severe COVID-19; 12.1% of infected patients (669 of 5,527) were classified as LCRI positive; and 3.1% (82 of 2,679) were anti-S1 IgG antibody nonreactive. 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 (odds ratio, 2.20 [95% CI, 1.16-4.18]). LIMITATIONS: Some outcomes were self-reported.

conclusionsHigher 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. PLAIN-LANGUAGE SUMMARY: Chronic kidney disease (CKD) affects approximately 1 in 7 US adults, yet its impact on COVID-19 outcomes, particularly in early stage CKD, remains incompletely understood. We analyzed pre-pandemic CKD stage data from 9 population-based US cohorts to assess their associations with the risk of severe COVID-19, symptom-defined long COVID, and postvaccination anti-spike 1 IgG levels. More advanced stages of CKD had a stronger relationship with severe COVID-19 and a lower anti-S1 antibody response. No consistent association was observed with symptom-defined long COVID, although its prevalence was higher among individuals with very high stage CKD. These findings suggest an altered vaccine-induced immunity and increased susceptibility to both acute and post-acute COVID-19 outcomes among persons with advanced CKD. Adults with advanced CKD may benefit from targeted preventive measures.

Indexed as

COVID-19Renal Insufficiency, ChronicAdultAgedFemaleGlomerular Filtration RateHospitalizationHumansMaleMiddle AgedPost-Acute COVID-19 SyndromeProspective StudiesSARS-CoV-2United StatesAnti-S1 IgG antibodychronic kidney diseasekidney dysfunctionlong COVIDprospective cohortSARS-CoV-2 infectionsevere COVID-19

Identifiers

PMID42362101
PMCPMC13377554

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