COVID-19 in Chronic Kidney Disease: The Impact of Old and Novel Cardiovascular Risk Factors

Abstract

Cardiovascular disease is a frequent complication and the most common cause of death in patients with CKD. Despite landmark medical advancements, mortality due to cardiovascular disease is still 20 times higher in CKD patients than in the general population, which is mainly due to the high prevalence of risk factors in this group. Indeed, in addition to traditional cardiovascular risk factors, CKD patients are exposed to nontraditional ones, which include metabolic, hormonal, and inflammatory alterations. The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought novel challenges for both cardiologists and nephrologists alike. Emerging evidence indicates that coronavirus disease 2019 (COVID-19) increases the risk of cardiovascular events and that several aspects of the disease may synergize with pre-existing cardiovascular risk factors in CKD patients. A better understanding of these mechanisms is pivotal for the prevention and treatment of cardiovascular events in this context, and we believe that additional clinical and experimental studies are needed to improve cardiovascular outcomes in CKD patients with COVID-19. In this review, we provide a summary of traditional and nontraditional cardiovascular risk factors in CKD patients, discussing their interaction with SARS-CoV-2 infection and focusing on CO­VID-19-related cardiovascular complications that may severely affect short- and long-term outcomes in this high-risk population.

Cardiovascular outcomes in patients with chronic kidney disease and COVID-19: a multi-regional data-linkage study

“…Whilst the majority of patients with COVID-19 are considered to have increased cardiovascular risk [ 29 ], few studies have examined the nature or extent of this risk in patients with CKD [ 30 ]. This is important given the well-recognised association between cardiovascular disease and CKD [ 12 , 13 ].…”

The evolving direct and indirect platforms for the detection of SARS-CoV-2

“…3 ) ( Khalili et al, 2021 ). In patients with chronic kidney disease (CKD), COVID-19 can increase the risk of cardiovascular events that are the most common cause of death in patients with CKD ( Podestà et al, 2021 ). There is also evidence about excessive release of inflammatory cytokines (cytokine storm) related to immune dysregulation in individuals with poor prognosis ( Bellinvia et al, 2020 ).…”

Langfristige körperliche und psychische Folgen chronischer Nierenerkrankungen

“…Die COVID-19-Pandemie hat nachdrücklich verdeutlicht, wie vulnerabel die Gruppe der Patient:innen mit chronischen Nierenerkrankungen ist. Auch wenn es noch Jahre dauern wird, alle Aspekte der COVID-19-Erkrankung zu untersuchen und zu verstehen, die Einfluss auf den Verlauf von Nierenerkrankungen, die Dialyse und die Nierentransplantation haben, ist bereits jetzt klar, dass Patient:innen mit einer chronischen Nierenerkrankung nach einer SARS-CoV-2-Infektion eine schlechtere Prognose haben [ 70 , 71 ]. Und umgekehrt haben Patient:innen mit einem schweren Verlauf der COVID-19-Erkrankung ein erhöhtes Risiko, ein akutes Nierenversagen und im weiteren Verlauf eine chronische Niereninsuffizienz zu entwickeln [ 72 – 75 ].…”