Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients

Bell, James B.; James, Ben; Al-Chalabi, Saif; Sykes, Lynne; Kalra, Philip A.; Green, Darren

doi:10.1186/s12882-021-02471-2

Cited by 21 publications

(26 citation statements)

References 27 publications

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“…Today the benefits of e-alerts are largely passive, and remains untackled by many institutions, especially those with limited resources or have no mandate to establish such a system. The benefits highlighted by national alerts systems in the UK [ 65 , 73 , 79 ] or in specific use case scenarios of nephrotoxic surveillance [ 41 , 85 , 91 ], or simply AKI surveillance [ 43 ], are valuable and provide an example of what is possible. To realize the full potential of AKI alerts, some rule modifications may be necessary in terms of how AKI is defined.…”

Section: Discussionmentioning

confidence: 99%

“…Beyond the algorithm for AKI detection, a consistent nationwide alert system seems like a challenge in North America and the studies published from the UK have generally shown to be beneficial from a detection and alerting standpoint [ 43 , 65 , 73 , [79] , [80] , [81] ]. Some studies as discussed below have also reported improved clinical outcomes [ 65 , 80 , 81 ].…”

Section: Serum Creatinine (Scr) For Diagnosing Akimentioning

confidence: 99%

“…<60 or >60 mL/mn/1.73 m 2 ) [ 41 ] and decline rates [ 42 ] may help inform risk status for screening AKI. For example, risk factors such as diabetes are common and indicate significant risk of AKI in both hospitals acquired AKI and community acquired AKI [ 43 , 44 ]. However active screening for AKI in diabetic patients has not been undertaken, despite higher rates of AKI in patients with diabetes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Alerting to acute kidney injury - Challenges, benefits, and strategies

Ivica

Sanmugalingham

Selvaratnam

2022

Practical Laboratory Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Serum Creatinine (Scr) For Diagnosing Akimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Alerting to acute kidney injury - Challenges, benefits, and strategies

Ivica

Sanmugalingham

Selvaratnam

2022

Practical Laboratory Medicine

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“…With regard to the distinction between community and hospital acquired AKI, often, a 48-hour threshold is used to identify CA-AKI [ 31 ]. Such a definition would preclude many patients in this study who were identified as having AKI on day 3 of admission.…”

Section: Discussionmentioning

confidence: 99%

Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study using the ISARIC–WHO clinical characterisation protocol

et al. 2022

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Background Acute kidney injury (AKI) is one of the most common and significant problems in patients with Coronavirus Disease 2019 (COVID-19). However, little is known about the incidence and impact of AKI occurring in the community or early in the hospital admission. The traditional Kidney Disease Improving Global Outcomes (KDIGO) definition can fail to identify patients for whom hospitalisation coincides with recovery of AKI as manifested by a decrease in serum creatinine (sCr). We hypothesised that an extended KDIGO (eKDIGO) definition, adapted from the International Society of Nephrology (ISN) 0by25 studies, would identify more cases of AKI in patients with COVID-19 and that these may correspond to community-acquired AKI (CA-AKI) with similarly poor outcomes as previously reported in this population. Methods and findings All individuals recruited using the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC)–World Health Organization (WHO) Clinical Characterisation Protocol (CCP) and admitted to 1,609 hospitals in 54 countries with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection from February 15, 2020 to February 1, 2021 were included in the study. Data were collected and analysed for the duration of a patient’s admission. Incidence, staging, and timing of AKI were evaluated using a traditional and eKDIGO definition, which incorporated a commensurate decrease in sCr. Patients within eKDIGO diagnosed with AKI by a decrease in sCr were labelled as deKDIGO. Clinical characteristics and outcomes—intensive care unit (ICU) admission, invasive mechanical ventilation, and in-hospital death—were compared for all 3 groups of patients. The relationship between eKDIGO AKI and in-hospital death was assessed using survival curves and logistic regression, adjusting for disease severity and AKI susceptibility. A total of 75,670 patients were included in the final analysis cohort. Median length of admission was 12 days (interquartile range [IQR] 7, 20). There were twice as many patients with AKI identified by eKDIGO than KDIGO (31.7% versus 16.8%). Those in the eKDIGO group had a greater proportion of stage 1 AKI (58% versus 36% in KDIGO patients). Peak AKI occurred early in the admission more frequently among eKDIGO than KDIGO patients. Compared to those without AKI, patients in the eKDIGO group had worse renal function on admission, more in-hospital complications, higher rates of ICU admission (54% versus 23%) invasive ventilation (45% versus 15%), and increased mortality (38% versus 19%). Patients in the eKDIGO group had a higher risk of in-hospital death than those without AKI (adjusted odds ratio: 1.78, 95% confidence interval: 1.71 to 1.80, p-value < 0.001). Mortality and rate of ICU admission were lower among deKDIGO than KDIGO patients (25% versus 50% death and 35% versus 70% ICU admission) but significantly higher when compared to patients with no AKI (25% versus 19% death and 35% versus 23% ICU admission) (all p-values <5 × 10−5). Limitations include ad hoc sCr sampling, exclusion of patients with less than 2 sCr measurements, and limited availability of sCr measurements prior to initiation of acute dialysis. Conclusions An extended KDIGO definition of AKI resulted in a significantly higher detection rate in this population. These additional cases of AKI occurred early in the hospital admission and were associated with worse outcomes compared to patients without AKI.

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“…With regards to the distinction between community and hospital acquired AKI, often a 48 hr threshold is used to identify CA-AKI [28]. Such a definition would preclude many patients in this study who were identified as having AKI on day 3 of admission.…”

Section: Discussionmentioning

confidence: 99%

Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study of the ISARIC cohort

Wainstein

MacDonald

Fryer

et al. 2022

Preprint

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Background: Acute kidney injury (AKI) is one of the most common and significant problems in patients with COVID-19. However, little is known about the incidence and impact of AKI occurring in the community or early in the hospital admission. The traditional KDIGO definition can fail to identify patients for whom hospitalization coincides with recovery of AKI as manifested by a decrease in serum creatinine (sCr). We hypothesized that an extended KDIGO definition, adapted from the International Society of Nephrology 0by25 studies, would identify more cases of AKI in patients with COVID-19 and that these may correspond to community-acquired AKI with similarly poor outcomes as previously reported in this population. Methods and Findings: All individuals in the ISARIC cohort admitted to hospital with SARS-CoV-2 infection from February 15th, 2020, to February 1st, 2021, were included in the study. Data was collected and analysed for the duration of a patient’s admission. Incidence, staging and timing of AKI were evaluated using a traditional and extended KDIGO (eKDIGO) definition which incorporated a commensurate decrease in serum creatinine. Patients within eKDIGO diagnosed with AKI by a decrease in sCr were labelled as deKDIGO. Clinical characteristic and outcomes – intensive care unit (ICU) admission, invasive mechanical ventilation and in-hospital death - were compared for all three groups of patients. The relationship between eKDIGO AKI and in-hospital death was assessed using survival curves and logistic regression, adjusting for disease severity and AKI susceptibility. 75,670 patients from 54 countries were included in the final analysis cohort. Median length of admission was 12 days (IQR 7, 20). There were twice as many patients with AKI identified by eKDIGO than KDIGO (31.7 vs 16.8%). Those in the eKDIGO group had a greater proportion of stage 1 AKI (58% vs 36% in KDIGO patients). Peak AKI occurred early in the admission more frequently among eKDIGO than KDIGO patients. Compared to those without AKI, patients in the eKDIGO group had worse renal function on admission, more in-hospital complications, higher rates of ICU admission (54% vs 23%) invasive ventilation (45% vs 15%) and increased mortality (38% vs 19%). Patients in the eKDIGO group had a higher risk of in-hospital death than those without AKI (adjusted OR: 1.78, 95% confidence interval: 1.71-1.8, p-value < 0.001). Mortality and rate of ICU admission were lower among deKDIGO than KDIGO patients (25% vs 50% death and 35% vs 70% ICU admission) but significantly higher when compared to patients with no AKI (25% vs 19% death and 35% vs 23% ICU admission) (all p values < 5x10-5). Limitations include ad hoc sCr sampling, exclusion of patients with less than two sCr measurements, and limited availability of sCr measurements prior to initiation of acute dialysis. Conclusions: The use of an extended KDIGO definition to diagnose AKI in this population resulted in a significantly higher incidence rate compared to traditional KDIGO criteria. These additional cases of AKI appear to be occurring in the community or early in the hospital admission and are associated with worse outcomes than those without AKI.

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Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients

Cited by 21 publications

References 27 publications

Alerting to acute kidney injury - Challenges, benefits, and strategies

Alerting to acute kidney injury - Challenges, benefits, and strategies

Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study using the ISARIC–WHO clinical characterisation protocol

Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study of the ISARIC cohort

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