Prolonged SARS‐CoV‐2 viral shedding in patients with chronic kidney disease

• Published in: Nephrology 2021-04, Vol.26 (4), p.328-332
• Main Authors: O'Sullivan, Eoin D., Lees, Jennifer S., Howie, Katie L., Pugh, Dan, Gillis, Keith A., Traynor, Jamie P., Macintyre, Iain, Mark, Patrick B.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; CKD; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - therapy; COVID-19 Nucleic Acid Testing; Cross-Sectional Studies; Female; Glomerular Filtration Rate; Hospitalization; Humans; Immune clearance; Kidney diseases; Linear Models; Male; Middle Aged; Patients; Polymerase chain reaction; Renal function; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; Renal Insufficiency, Chronic - virology; Reverse Transcriptase Polymerase Chain Reaction; Reverse transcription; SARS-CoV-2 - physiology; SARS‐CoV‐2; Scotland; Severe acute respiratory syndrome coronavirus 2; Time Factors; viral shedding; Virus Shedding
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13844

Recent World Health Organization guidance has aimed to provide pragmatic guidance acknowledging the role of sequential nasopharyngeal swabs taken >24 hours apart for SARS‐CoV‐2 in high‐risk populations. Patients with chronic kidney disease (CKD) are known to have an altered immune milieu which may be associated with a delay in viral clearance. Here, a cross‐sectional observational study of 138 patients admitted with SARS‐CoV‐2 infection at two large regional hospitals in Scotland, UK examined the median time to two consecutive negative nasopharyngeal swabs for SARS‐CoV‐2 in an inpatient population. The median time from admission to the first of two consecutive negative nasopharyngeal swabs was 18 days (range = 1‐44) in patients with CKD, compared with 11 days (range: 1‐71) in patients without CKD (P = .0007). Multivariable linear regression analysis using explanatory variables of age, sex, SARS‐CoV‐2 disease severity, key comorbidities and renal function showed that declining estimated glomerular filtration rate was independently associated with prolonged time to viral clearance. Our data suggest that patients with CKD who are admitted to hospital with SARS‐CoV‐2 take longer to achieve sequential negative nasopharyngeal swab reverse transcription‐polymerase chain reaction results than those without CKD. This has implications for renal service provision, discharge planning and hospital capacity as well as a direct impact on patients due to extended hospital stay, anxiety and stigmatisation. SUMMARY AT A GLANCE In this study, the authors investigated the time between admissions to SARS‐CoV‐2 virus‐negative nasopharyngeal swabs in inpatients. They found that CKD patients had longer time to viral clearance than non‐CKD patients, and concluded that longer CKD patients had longer time to viral clearance, affecting renal service delivery, discharge planning, and admission capacity. In addition, potential anxiety and stigma have a direct impact on the patient.