Clinical profile and outcomes of COVID-19 patients with acute kidney injury: a tertiary centre experience from South India

Abstract

Aim The rates of development of acute kidney injury (AKI) in COVID-19 have been variably reported from across the world. Prevalence and outcomes of AKI in hospitalised COVID-19 patients in India has not been studied well. Methods This was a retrospective observational study amongst adult hospitalised COVID-19 patients admitted at a tertiary care centre between May 1 and October 31, 2020. We estimated the prevalence of AKI and outcomes including mortality and acute kidney disease (AKD) at the time of discharge. Regression analysis was done to study the factors associated with mortality and AKD. Results Out of 2650 hospitalised patients with COVID-19, 190 (7.2%) patients developed AKI. Mean age of patients with AKI was 62.6 years, 81.6% were male. Comorbidities included diabetes mellitus in 72.1%, hypertension in 66.8%, heart disease in 30% and chronic kidney disease (CKD) in 22.6%. Most patients had stage 1 AKI (71.1%). Overall mortality in patients with AKI was 22.1%, 75% in those requiring dialysis and 74.5% in those requiring ICU. Amongst survivors without pre-existing CKD, 40.9% patients had acute kidney disease at the time of discharge. Higher age, stage 3 AKI and need for mechanical ventilation were associated with higher mortality. On multivariable regression, factors associated with AKD at discharge included pre-existing heart disease and severe albuminuria during hospitalisation. Conclusion In our study population, we found a low prevalence of AKI. Mortality was high in AKI patients requiring ICU care and dialysis. Amongst survivors, a significant percentage had AKD at the time of discharge.

Correlation of AKI with risk factors, ventilatory support, renal replacement therapy in a cohort of COVID-19 patients

“…In our study, among patients who developed AKI, 54.6% required ICU care, 72.09% required ventilation, and 24.4% died. Thus, our patients overall mortality rate in AKI is consistent with the study conducted by Sindhu and Prasad[ 12 ] but is lower than other studies[ 13 25 ] that reported mortality rates between 35% and 45%. This might be due to the fact that more patients in our study had a lower stage of AKI than those in other studies.…”

“…The reported incidence of AKI as between 1% and 42% among those infected with COVID-19 is currently only based on reports from small case series and retrospective studies from China,[ 21 ] Europe,[ 22 23 ] the United States,[ 19 ] and India. [ 12 13 24 ] The variances between previous studies and our investigation might be related due to variances in patient populations and geographic location. Our AKI rates are consistent with other recent studies from India,[ 12 13 ] which found that AKI incidence is between 7 and 7.2%.…”

“…[ 12 13 24 ] The variances between previous studies and our investigation might be related due to variances in patient populations and geographic location. Our AKI rates are consistent with other recent studies from India,[ 12 13 ] which found that AKI incidence is between 7 and 7.2%. Due to the high case burden in India, as hospitals were choked with patients, they were advised to stay at home until the oxygen saturation measured by oximeter fell below 94%; this probably led to the increased case burden of AKI at admission.…”

“…However, information on the occurrence and outcomes of AKI in COVID-19 on larger studies in India is limited. [ 11 12 13 ] This single-center, retrospective study, aimed to report the risk factors, incidence, outcomes, and mortality among patients with acute kidney injury in COVID-19. Between the first and second waves of the pandemic, we studied demographic factors and clinical outcomes of those infected with COVID-19.…”

Mechanisms of SARS-CoV-2 Infection-Induced Kidney Injury: A Literature Review

“…We performed a systematic search in PubMed to identify recently published large cohort studies related to AKI in patients with COVID-19. We used the search terms “Coronavirus”, “COVID-19”, “SARS-CoV-2”, “acute kidney damage”, “acute kidney injury”, “AKI” and found that the incidence of AKI was higher in severe COVID-19 patients and AKI was strongly associated with high mortality ( Table 1 ) ( Bell et al., 2021 ; Chen et al., 2021 ; Jewell et al., 2021 ; Kilis‐pstrusinska et al., 2021 ; Marques et al., 2021 ; Procaccini et al., 2021 ; Rahimzadeh et al., 2021 ; Scarpioni et al., 2021 ; Sullivan et al., 2021 ; Strohbehn et al., 2021 ; Wan et al., 2021 ; Hung et al., 2022 ; Hsu et al., 2022 ; Sindhu et al., 2022 ). Many possible mechanisms for COVID-19-induced kidney injury have been proposed, including the direct kidney injury mediated by the combination of virus and ACE2.…”