Kidney disease & COVID-19

Know your risk

People with kidney disease and other severe chronic medical conditions are at higher risk for more severe illness.

People on dialysis can have weaker immune systems, making it harder to fight infections. However, it is important to know that kidney patients need to continue with their regularly scheduled dialysis treatments and to take necessary precautions as recommended by their healthcare team.

People who have received a kidney transplant need to take anti-rejection medicines (also known as immunosuppressive medicines). These medicines work by keeping the immune system less active, which can make it harder to fight infections. It is important to keep taking these medicines. It is also important to wash hands, maintain good hygiene and follow the recommendations from their healthcare team.

Take precautions

Older adults and people with kidney disease or other severe chronic medical conditions are at higher risk for more serious COVID-19 illness. If you are at higher risk of getting very sick from COVID-19, you should:

• Stock up on supplies
• Take everyday precautions to keep space between yourself and others
• When you go out in public, keep away from others who are sick, limit close contact
• Wash your hands often
• Avoid crowds as much as possible
• During an outbreak in your area, stay home as much as possible.

Please remember that if you are on dialysis, you should not miss your treatments. Contact your clinic if you feel sick or have any questions or concerns.

If you have a kidney transplant, it is important to remember to keep taking your anti-rejection medicines, maintain good hygiene and follow the recommendations from your healthcare team. Contact your healthcare team with any questions or concerns.

You can learn more about how kidney patients can be prepared for COVID-19 with this NKF resource.

Wear your face mask

• Wear a mask indoors and outdoors
• Wear the mask over your nose and mouth and secure it under your chin
• Make sure the mask fits snugly against the sides of your face
• In cold weather, wear your mask under your scarf, ski mask, or balaclava
• Keep a spare mask handy in case your mask becomes wet from moisture in your breath or from snow or rain.

Autoimmune diseases

With an autoimmune disease, the body’s own immune system attacks the body's own cells, tissues and organs. Many of these diseases, such as IgA and lupus, can also attack and harm the kidney.

People with an autoimmune disease may be prescribed certain immunosuppressive medicines by their healthcare professional (depending on the disease and other factors). These medicines work by keeping the immune system less active, which can make it harder for the body to fight infections.

Recommendations to reduce risk from COVID-19:

• keep taking any medicine as prescribed
• wash your hands
• maintain good hygiene
• follow recommendations from your healthcare team

You should contact your healthcare professional for any questions or concerns.

You can find information on general COVID-19 prevention at the Centers for Disease Control (CDC) website.

Underlying medical conditions

There are other underlying medical conditions that people may have in addition to having undergone a kidney transplant recipient or dialysis treatment.

Some of these conditions are:

• Chronic lung disease or moderate-to-severe asthma
• Serious heart conditions
• Immunocompromised due to cancer treatment, smoking, bone marrow transplantation, immune deficiencies, HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
• Severe obesity (body mass index [BMI] of 40 or higher)
• Diabetes
• Liver disease

COVID-19 patients at significant risk of AKI

A new comprehensive report shows that people hospitalized with COVID-19 are at significant risk of AKI, which can lead to serious illness, dialysis, and even death. The study found patients with COVID-19, who were hospitalized between March 11 and April 26, were twice as likely to develop AKI as compared to non-COVID patients who developed AKI during the same time period in 2019 – 56.9% versus 25.1% respectively. AKI appears to be a marker of COVID-19 infection severity and the mortality rate is higher for these patients.

Various COVID-19-related effects that are thought to contribute to AKI include kidney tubular injury (acute tubular necrosis) with septic shock, microinflammation, increased blood clotting, and probable direct infection of the kidney. Most patients with COVID-19-related AKI who recover continue to have low kidney function after discharge from the hospital.

Long term implications of acute kidney injury

It’s recommended that recovered COVID-19 patients who had an AKI or ARF should be seen regularly by a kidney doctor, because their risk of developing chronic kidney disease is higher than others. COVID-19 patients who did not develop an AKI, but who had blood and/or protein in their urine, should be monitored since they are at increased risk of developing chronic- and end-stage-kidney disease.

The link to kidney disease

Acute kidney injury, also known as acute renal failure (ARF), is not the same as chronic kidney disease (CKD), which will eventually lead to chronic kidney failure (CKF). Neither CKD or CKF are reversible diseases. Detecting proteins and/or blood in urine labs is an early sign of kidney involvement in people with confirmed COVID-19.

Kidney failure in otherwise healthy adults

There have been recent reports of nonelderly adults infected with COVID-19 who have developed an acute kidney injury (AKI) — sudden loss of kidney function. These adults did not have underlying medical conditions. With proper treatment, including dialysis in severe cases, AKI can be reversible.

Unfortunately, in times of uncertainty, there are people who look to prey upon those who are vulnerable. The US Food and Drug Administration (FDA) reports there are unscrupulous companies and individuals looking to fraudulently profit by scamming people who want to prevent and/or treat COVID-19.

Beware of false promises

Products that claim to cure, mitigate, treat, or prevent disease, but are not proven safe and effective for those purposes, defraud consumers of money and can place consumers at risk for serious harm. Fraudulent COVID-19 products may come in many varieties, including dietary supplements, such as vitamins and minerals, foods (garlic), as well as questionable products purporting to be drugs, herbal remedies, immune boosters, or medical devices. Using these products may lead to delays in getting proper diagnosis and treatment for COVID-19.

The FDA urges consumers and patients to talk to their healthcare providers and to follow the advice from federal public health agencies about how to prevent the spread and treatment options for people with COVID-19.

Feelings of stress or depression

"It’s common for people who have been diagnosed with chronic kidney disease, patients on dialysis, and those who have received kidney transplants to feel sad and depressed. In fact, studies show that 20% to 40% of people with kidney failure may also have depression. While the risk of severe illness due to COVID-19 remains low in the general population, people who have a chronic illness or who are taking immunosuppressant drugs are at an increased risk of becoming very ill. These fears are real – and the worry and stress can lead to an even greater bout of depression. 

Coping strategies

If you are feeling more depressed than usual, The Centers for Disease Control has some great tips for helping you to manage your stress and anxiety.

For more information

• 5 Ways to Cope
• Dialysis Depression – Patients Helping Patients
• Depression and kidney disease
• Injecting hope back into the world
• Stress and Your Kidneys