Renal involvement is frequent in COVID-19 (4–37%). This study evaluated the incidence and risk factors of acute kidney injury (AKI) in hospitalized patients with COVID-19.Methodology: This study represents a prospective cohort in a public and tertiary university hospital in São Paulo, Brazil, during the first 90 days of the COVID-19 pandemic, with patients followed up until the clinical outcome (discharge or death).Results: There were 101 patients hospitalized with COVID-19, of which 51.9% were admitted to the intensive care unit (ICU). The overall AKI incidence was 50%; 36.8% had hematuria or proteinuria (66.6% of those with AKI), 10.2% had rhabdomyolysis, and mortality was 36.6%. Of the ICU patients, AKI occurred in 77.3% and the mortality was 65.4%. The mean time for the AKI diagnosis was 6 ± 2 days, and Kidney Disease Improving Global Outcomes (KDIGO) stage 3 AKI was the most frequent (58.9%). Acute renal replacement therapy was indicated in 61.5% of patients. The factors associated with AKI were obesity [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.04–2.76, p < 0.05] and the APACHE II score (OR 1.97, 95% CI 1.08–2.64, p < 0.05). Mortality was higher in the elderly (OR 1.03, 95% CI 1.01–1.66, p < 0.05), in those with the highest APACHE II score (OR 1.08, 95% CI 1.02–1.98, p < 0.05), and in the presence of KDIGO stage 3 AKI (OR 1.11, 95% CI 1.05–2.57, p < 0.05).Conclusion: AKI associated with severe COVID-19 in this Brazilian cohort was more frequent than Chinese, European, and North American data, and the risk factors associated with its development were obesity and higher APACHE II scores. Mortality was high, mainly in elderly patients, in those with a more severe disease manifestation, and in those who developed KDIGO stage 3 AKI.

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IntroductionElderly patients with COVID-19 are at a higher risk of severity and death as not only several comorbidities but also aging itself has been considered a relevant risk factor. Acute kidney injury (AKI), one of the worst complications of SARS-CoV-2 infection, is associated with worse outcomes. Studies on AKI with COVID-19 in Latin-American patients of older age remain scarce.ObjectivesTo determine AKI incidence and the risk factors associated with its development, as well as to compare outcome of elderly patients with or without AKI associated with SARS-CoV-2 infectionMethodsThis retrospective cohort study evaluated patients with SARS-CoV2 infection admitted to a Public Tertiary Referral Hospital from 03/01/2020 to 12/31/2020, from admission to resolution (hospital discharge or death). Demographic, clinical, and laboratory data were collected from patients during hospitalization. Daily kidney function assessment was performed by measuring serum creatinine and urine output. AKI was diagnosed according to KDIGO 2012 criteria.ResultsOf the 347 patients with COVID-19 admitted to our hospital during the study period, 52.16% were elderly, with a median age of 72 years (65- 80 years). In this age group, most patients were males (56.91%), hypertensive (73.48%), and required ICU care (55.25%). AKI overall incidence in the elderly was 56.9%, with higher frequency in ICU patients (p < 0.001). There was a predominance of KDIGO 3 (50.48%), and acute kidney replacement therapy (AKRT) was required by 47.57% of the patients. The risk factors associated with AKI development were higher baseline creatinine level (OR 10.54, CI 1.22 -90.61, p = 0.032) and need for mechanical ventilation (OR 9.26, CI 1.08-79.26, p = 0.042). Mortality was also more frequent among patients with AKI (46.41%vs24.7%, p < 0.0001), with death being associated with CPK level (OR 1.009, CI 1.001-1.017, p = 0.042), need for mechanical ventilation (OR 17.71, CI 1.13-277.62, p = 0.002) and KDIGO 3 (OR 2.017 CI 1.039 -3.917, p = 0.038).ConclusionAKI was frequent among the elderly hospitalized with COVID-19 and its risk factors were higher baseline creatinine and need for mechanical ventilation. AKI was independently associated with a higher risk of death.

Background and Aims In the different waves of the pandemic caused by the SARS-CoV-2 virus, the elderly continued to be affected with more severe cases of the disease and possible progression to death. The objective of this study was to compare the incidence of acute kidney injury (AKI) in the elderly during the first and second waves of the pandemic in Brazil; the risk factors associated with its development and death. Method Retrospective cohort study that evaluated patients over 60 years of age admitted to a Public, Tertiary, and Reference Hospital for COVID-19 with a diagnosis of SARS-CoV-2 infection, from March to December/2020 (first wave), and from January to May/2021 (second wave), from admission to hospital outcome (discharge or death). Results Throughout the entire period, 434 elderly patients diagnosed with COVID-19 were admitted, 173 in the first wave and 261 patients in the second wave. These two groups of patients were similar in terms of age (71±8.41 vs 70±8.03, p = 0.3239), need for intensive care unit admission (56.1% vs 58.2%, p = 0.655), vasoactive drug use (43.9% vs 52.9%, p = 0.068), need for mechanical ventilation (43.4% vs 52.5%, p = 0.062), higher APACHE values (19±7.53 vs 17 ±5.64, p = 0.312), SOFA (9±4.07 vs 7±3.56, p = 0.332), CPK (96.5±705.74 vs 150±4830.47, p = 0.0886), the incidence of AKI (56.6% vs 58.6%, p = 0.684) and mortality (46.8% vs 55.2%, p = 0.088). However, they differed in terms of white race (77.5% vs 86.8%, p = 0.011), use of corticosteroids (56.6 vs 93.9%, p < 0.001), presence of proteinuria (44.8% vs 58.2%, p = 0.031), higher values of ATN-ISS (0.76±0.23 vs 0.86±0.21, p = 0.004) and D Dimer (5098±5995.04 vs 2436.5±8398.38, p = 0.0147). The two waves were similar regarding the following factors associated with the development of AKI: higher baseline creatinine, CPK, and D-Dimer values during hospitalization, higher APACHE values, need for mechanical ventilation, use of vasoactive drugs, presence of proteinuria and hematuria in the urine 1 on hospital admission. There was a difference between the waves regarding males (47.40% vs 64.08%, p = 0.037), a relevant factor in the development of AKI in the first wave; while the presence of SAH (63.9% vs 77.8%, p = 0.0202), the use of ACEI/ARB (42.6% vs 56.2%, p 0.0412) and the filtration rate basal glomerular (91±29.61 vs 80.5±26.79, p = 0.0021) were observed as factors associated with AKI only in the second wave. In the logistic regression of both waves, mechanical ventilation remained a risk factor for the development of AKI. In the first wave, the highest baseline creatinine value was also maintained as a risk factor (OR 10.54, CI 1.22-90.61, p = 0.032); while in the second, SAH (OR 1.646, CI 1.150-1.839, p = 0.018), hematuria (OR 1.681, CI 1.124-1.822, p = 0.018) and higher value of D Dimer (OR 1.977, CI 2.000-2.003, p = 0.023) remained as relevant factors for the development of AKI. As factors associated with mortality in the first wave, the highest value of CPK (OR 1.009, CI 1.001-1.017, p = 0.042) and the need for mechanical ventilation (OR 17.71, CI 1.13-277.62, p = 0.002). In the second wave, the factors associated with death were the presence of DM (OR 4.875 CI 2.602-7.094, p = 0.001), ARF (OR 1.858, CI 1.070-1.287, p < 0.001), need for dialysis (OR 1.813, CI 1.086-1.407, p < 0.001), proteinuria (OR 1.968, CI 1.142-1.913, p = 0.032) and higher ATN-ISS value (OR 5865.316, CI 1.325-25967740, p = 0.043). Conclusion The incidence of AKI was similar between the two waves of the pandemic; however, its severity was greater in the second wave, in which it was identified as a factor associated with death. Despite the greater severity of AKI, evidenced by the higher ATN-ISS, there was no higher patient mortality during the second wave of the pandemic.