Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19

Abstract

IMPORTANCE Acute kidney injury (AKI) occurs in up to half of patients hospitalized with coronavirus disease 2019 (COVID-19). The longitudinal effects of COVID-19-associated AKI on kidney function remain unknown. OBJECTIVE To compare the rate of change in estimated glomerular filtration rate (eGFR) after hospital discharge between patients with and without COVID-19 who experienced in-hospital AKI. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at 5 hospitals in Connecticut and Rhode Island from March 10 to August 31, 2020. Patients who were tested for COVID-19 and developed AKI were screened, and those who survived past discharge, did not require dialysis within 3 days of discharge, and had at least 1 outpatient creatinine level measurement following discharge were included. EXPOSURES Diagnosis of COVID-19. MAIN OUTCOMES AND MEASURES Mixed-effects models were used to assess the association between COVID-19-associated AKI and eGFR slope after discharge. The secondary outcome was the time to AKI recovery for the subgroup of patients whose kidney function had not returned to the baseline level by discharge. RESULTS A total of 182 patients with COVID-19-associated AKI and 1430 patients with AKI not associated with COVID-19 were included. The population included 813 women (50.4%); median age was 69.7 years (interquartile range, 58.9-78.9 years). Patients with COVID-19-associated AKI were more likely to be Black (73 [40.1%] vs 225 [15.7%]) or Hispanic (40 [22%] vs 126 [8.8%]) and had fewer comorbidities than those without COVID-19 but similar rates of preexisting chronic kidney disease and hypertension. Patients with COVID-19-associated AKI had a greater decrease in eGFR in the unadjusted model (−11.3; 95% CI,-22.1 to −0.4 mL/min/1.73 m 2 /y; P = .04) and after adjusting for baseline comorbidities (−12.4; 95% CI,-23.7 to −1.2 mL/min/1.73 m 2 /y; P = .03). In the fully adjusted model controlling for comorbidities, peak creatinine level, and in-hospital dialysis requirement, the eGFR slope difference persisted (−14.0; 95% CI,-25.1 to −2.9 mL/min/1.73 m 2 /y; P = .01). In the subgroup of patients who had not achieved AKI recovery by discharge (n = 319), COVID-19-associated AKI was associated with decreased kidney recovery during outpatient follow-up (adjusted hazard ratio, 0.57; 95% CI, 0.35-0.92). CONCLUSIONS AND RELEVANCE In this cohort study of US patients who experienced in-hospital AKI, COVID-19-associated AKI was associated with a greater rate of eGFR decrease after discharge compared with AKI in patients without COVID-19, independent of underlying comorbidities or AKI (continued) Key Points Question What is the association between coronavirus disease 2019 (COVID-19) in patients with acute kidney injury and the longitudinal trajectory of estimated glomerular filtration rate? Findings In this cohort study of 1612 patients with acute kidney injury monitored after their index hospitalization, estimated glomerular filtration rate declined by 11.3 mL/min/ 1.73 m 2 per year faster in patients ...

Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19

“…The burden of this association is estimated to confer about five-fold excess risk of mortality in patients with AKI and 13-fold in subjects with unrecovered AKI. Detection of vulnerable patients at risk for AKI, prevention and supportive strategy in patients prone to AKI could improve the prognosis of these patients and prevent long-term consequences [ 53 ]. According to national health policies, we suggest implementing home assistance of infected patients to minimize the surge of critically ill patients in already overwhelmed hospitals.…”

Urine Test Predicts Kidney Injury and Death in COVID-19

“…In addition, while we sought rapid diagnosis of COVID-19 associated kidney damage at the time of hospital admission, we were not able to collect urine samples on subsequent days, precluding comparative studies of urinary biomarker kinetics. A recent publication by Nugent et al 32 pointed to the need for prolonged patient follow up to determine residual injury of the kidney and to mitigate chronic forms of AKI, and subsequent measurements of uNGAL and uKIM-1 during hospitalization could have provided additional prognostic information. Nonetheless, the level of uNGAL on hospital admission correlated strongly with strict AKIN definitions and identified patients at highest risk of critical illness and death independently of other established risk factors.…”

Post-COVID-19 rehabilitation: a special look at chronic kidney disease patients

“…Regardless of whether kidney function is altered on admission or developed during hospitalization, many people experience kidney function loss after hospital discharge [ 29 ]. A significant number requires long-term follow-up due to incomplete recovery of kidney function, continuous interstitial inflammation, loss of renal vascular cell regenerative potential, and hypertension [ 21 ].…”