Changes of Acute Kidney Injury Epidemiology during the COVID-19 Pandemic: A Retrospective Cohort Study

Abstract

To evaluate the impact of the Coronavirus Disease-19 (COVID-19) pandemic on the epidemiology of acute kidney injury (AKI) in hospitalized patients, we performed a retrospective cohort study comparing data of patients hospitalized from January 2016 to December 2019 (pre-COVID-19 period) and from January to December 2020 (COVID-19 period, including both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative and positive patients). AKI was classified by evaluating the kinetics of creatinine levels. A total of 51,681 patients during the pre-COVID-19 period and 10,062 during the COVID-19 period (9026 SARS-CoV-2-negative and 1036 SARS-CoV-2-positive) were analyzed. Patients admitted in the COVID-19 period were significantly older, with a higher prevalence of males. In-hospital AKI incidence was 31.7% during the COVID-19 period (30.5% in SARS-CoV-2-negative patients and 42.2% in SARS-CoV-2-positive ones) as compared to 25.9% during the pre-COVID-19 period (p < 0.0001). In the multivariate analysis, AKI development was independently associated with both SARS-CoV-2 infection and admission period. Moreover, evaluating the pre-admission estimated glomerular filtration rate (eGFR) we found that during the COVID-19 period, there was an increase in AKI stage 2–3 incidence both in patients with pre-admission eGFR < 60 mL/min/1.73 m2 and in those with eGFR ≥ 60 mL/min/1.73 m2 (“de novo” AKI). Similarly, clinical outcomes evaluated as intensive care unit admission, length of hospital stay, and mortality were significantly worse in patients admitted in the COVID-19 period. Additionally, in this case, the mortality was independently correlated with the admission during the COVID-19 period and SARS-CoV-2 infection. In conclusion, we found that during the COVID-19 pandemic, in-hospital AKI epidemiology has changed, not only for patients affected by COVID-19. These modifications underline the necessity to rethink AKI management during health emergencies.

Fluid Overload is Associated with Poor Prognosis in Hospitalized Patients with Covid-19 and Acute Kidney Injury

“…Progression and longer duration of AKI in patients with Covid-19 was widely reported in different centers worldwide 17,18,22,24,25 . Likewise, severity of respiratory failure, multiorgan involvement, mechanical ventilation, and ICU admission were consistent ndings among patients who progressed to AKI stage 3 3,17−19 .…”

“…Acute Kidney Injury is one of the most common complications of Covid-19 and it has been associated with increased risk of death, prolonged stay in hospital, and need for RRT 2,3,14 . Although age, male sex, and previous uncontrolled comorbidities, such as cardiovascular disease, diabetes and CKD, have been independently associated with worst outcomes among patients with Covid-19 and AKI, few of them are relatively modi able during hospitalization that could improve prognosis 7,[14][15][16][17][18][19][20][21][22][23][24][25][26] . Likewise, data from previous studies have only focused on clinical and biochemical characteristics and have not widely analyzed patient's volume status in non-acute heart failure context and/or previously treated with RRT 6,15,27 .…”

Prudent use of NSAIDs in patients with COVID-19, Dengue, and Chikungunya

“…3 This is particularly crucial because clinical experience and publications have shown that kidney involvement was found up to 75% of the patients with COVID-19. 4 Similarly, obese, elderly and liver compromised patients with COVID-19 are in increased risk of hospitalization/ICU admission. Also, liver injury and abnormal liver function reported in nearly onefourth to half of the hospitalized patients or patients recovered from COVID-19.…”

Judicious uses of NSAIDs in patients with COVID-19, dengue, and chikungunya

“…[3] is is particularly crucial because clinical experience and publications have shown that kidney involvement was found in up to 75% of the patients with COVID-19. [4] Similarly, obese, elderly, and liver compromised patients with COVID-19 are at increased risk of hospitalization/ICU admission. Furthermore, liver injury and abnormal liver function were reported in nearly one-fourth to half of the hospitalized patients or patients who recovered from COVID-19.…”