The impact of COVID-19 in diabetic kidney disease and chronic kidney disease: A population-based study

Main Article Content

Juan Alonso Leon-Abarca
Roha Saeed Memon
Bahar Rehan
Maimoona Iftikhar
Antara Chatterjee


SARS-CoV-2, COVID-19, Chronic Kidney Disease, Diabetic Nephropathy


Background: The spectrum of pre-existing renal disease is known as a risk factor for severe COVID-19 outcomes. However, little is known about the impact of COVID-19 on patients with diabetic nephropathy in comparison to patients with chronic kidney disease. Methods: We used the Mexican Open Registry of COVID-19 patients 11 to analyze anonymized records of those who had symptoms related to COVID-19 to analyze the rates of SARS-CoV-2 infection, development of COVID-19 pneumonia, admission, intubation, Intensive Care Unit admission and mortality. Robust Poisson regression was used to relate sex and age to each of the six outcomes and find adjusted prevalences and adjusted prevalence ratios. Also, binomial regression models were performed for those outcomes that had significant results to generate probability plots to perform a fine analysis of the results obtained along age as a continuous variable. Results:  The adjusted prevalence analysis revealed that that there was a a 87.9% excess probability of developing COVID-19 pneumonia in patients with diabetic nephropathy, a 5% excess probability of being admitted, a 101.7% excess probability of intubation and a 20.8% excess probability of a fatal outcome due to COVID-19 pneumonia in comparison to CKD patients (p<0.01).  Conclusions: Patients with diabetic nephropathy had nearly a twofold rate of COVID-19 pneumonia, a higher probability of admission, a twofold probability of intubation and a higher chance of death once admitted compared to patients with chronic kidney disease alone. Also, both diseases had higher COVID-19 pneumonia rates, intubation rates and case-fatality rates compared to the overall population.


Download data is not yet available.


Metrics Loading ...
Abstract 267 | PDF Downloads 45


1. World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 72.2020 Apr 1.
2. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020.
3. Sidorenkov G, Navis G. Safety of ACE inhibitor therapies in patients with chronic kidney disease. Expert Opin Drug Saf. 2014. Doi: 10.1517/14740338.2014.951328
4. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. Am J Virol. 2020.
5. Booth CM, Matukas LM, Tomlinson GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003.
6. Matsuyama R, Nishiura H, Kutsuna S, Hayakawa K, Ohmagari N. Clinical determinants of the severity of Middle East respiratory syndrome (MERS): a systematic review and meta-analysis. BMC Public Health. 2016.
7. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Available at:
8. World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. Available at:
9. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). November 2019. Available at:
10. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020.
11. Secretaría de Salud. Datos Abiertos - Dirección General de Epidemiología. Gobierno de México. [2020 Jun 1; 2020 Jun 2]. Available from:
12. Vandenbroucke JP, Von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007 Oct 16;4(10):e297.
13. Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020;323:1612-4.
14. Centers for Disease Control and Prevention (CDC). People of Any Age with Underlying Medical Conditions. Coronavirus Disease 2019 (COVID-19). 2020. Available from:
15. Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol. 2020;52:1193-4.
16. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55:2000547.
17. D'Marco L, Puchades MJ, Romero-Parra M, Gorriz JL. Diabetic Kidney Disease and COVID-19: The Crash of Two Pandemics. Front Med (Lausanne). 2020;7:199.
18. Pyram R, Kansara A, Banerji MA, Loney-Hutchinson L. Chronic kidney disease and diabetes. Maturitas. 2012 Feb 1;71(2):94-103.
19. Warram JH, Gearin G, Laffel L, et al. Effect of duration of type I diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/ creatinine ratio. J Am Soc Nephrol 1996;7:930e7.
20. Reenders K, de Nobel E, van den Hoogen HJ, et al. Diabetes and its long-term complications in general practice: a survey in a well-defined population. Fam Pract 1993;10:169e72.
21. Weir MR. Albuminuria predicting outcome in diabetes: incidence of microalbuminuria in Asia-Pacific Rim. Kidney Int 2004;66:S38e9.
22. Hussain A, Bhowmik B, do Vale Moreira N. COVID-19 and diabetes: Knowledge in progress. Diabetes Research and Clinical Practice. 2020;162:108142.
23. Akbar D. Bacterial pneumonia: comparison between diabetics and non-diabetics. Acta Diabetologica. 2001;38(2):77-82.
24. Bode B, Garrett V, Messler J, et al. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. Journal of Diabetes Science and Technology. 2020;14(4):813-821.
25. Iacobellis G, Penaherrera C, Bermudez L, et al. Admission hyperglycemia and radiological findings of SARS-CoV2 in patients with and without diabetes. Diabetes Research and Clinical Practice. 2020;164:108185.
26. Brufsky A. Hyperglycemia, hydroxychloroquine, and the COVID‐19 pandemic. Journal of Medical Virology. 2020;92(7):770-775.
27. Betjes MG. Immune cell dysfunction and inflammation in end-stage renal disease. Nat Rev Nephrol. 2013;9:255-65.
28. Imig JD, Ryan MJ. Immune and inflammatory role in renal disease. Compr Physiol. 2013;3(2):957-76.
29. Fan C, Li K, Ding Y, et al. ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection. medRxiv. 2020.
30. Chou CY, Wang SM, Liang CC, et al. Risk of pneumonia among patients with chronic kidney disease in outpatient and inpatient settings: a nationwide population-based study. Medicine (Baltimore). 2014;93:e174.
31. Sibbel S, Sato R, Hunt A, et al. The clinical and economic burden of pneumonia in patients enrolled in Medicare receiving dialysis: a retrospective, observational cohort study. BMC Nephrol. 2016;17:199.
32. Tang B, Li S, Xiong Y, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia in a Hemodialysis Patient. Kidney Med. 2020.
33. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97:829-38.