Microvascular disease in diabetes and severe COVID-19 outcomes – Authors' reply

Abstract

We thank Antonella Corcillo and colleagues for their interest in our Article. We fully agree with them on the importance of the association between microvascular disease and severe COVID-19 and its manifestation as associations with reduced estimated glomerular filtration rate (eGFR), albuminuria, and retinopathy. We also agree that the role of endothelial dysfunction in microvascular disease in diabetes suggests a common mechanism for the association with severe COVID-19. Indeed, in preliminary drafts from our Article we discussed this point, but space requirements meant that it was not included in the final version. Indeed, there is increasing recognition of the involvement of endothelial damage and microvascular dysfunction in COVID-19. Endothelial dysfunction and microvascular disease are common in diabetes. Albuminuria, reduced renal function, and retinopathy are all manifestations of endothelial damage and microvascular disease and all were associated with severe COVID-19 in our study. Regarding whether more advanced stages of chronic kidney disease were associated with worse COVID-19 outcomes, as observed in several studies, we note that this association is reported in Supplementary Table 6 of the appendix of our Article where we show that an eGFR of less than 30 mL/min per 1·73 m² or being on renal replacement therapy was associated with a 2·37 times increased risk of severe COVID-19.

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https://doi.org/10.1016/S2213-8587(21)00055-3