COVID-19-associated AKI

Matsumoto, Kenki; Prowle, John R.

doi:10.1097/mcc.0000000000000988

Cited by 21 publications

(27 citation statements)

References 71 publications

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“…Our results for the prevalence of AKI (30% overall, 52.1% in ICU patients), odds of mortality (3.5 times higher for AKI vs no AKI), and mean LOS (11.9 days) are consistent with prior studies that extend past the first few months of the pandemic. 11,23 Recent reviews and meta-analyses that include many studies of the early pandemic period reported the following ranges: 28% to 34% 11,14,15,40 prevalence of overall AKI, 46% to 77% prevalence of AKI in ICU patients, 11,14,40 and 2.55 to 23.09 for OR for mortality. 41 Furthermore, in a study of AKI in COVID patients during all of 2020, HR (95% CI) for mortality was 3.8 (3.24-4.45), and mean LOS was 10.4 days.…”

Section: Discussionmentioning

confidence: 99%

“…3,10 JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH AKI is now known to be a common complication of COVID-19, but it is unclear whether COVID-19 affects the kidneys directly, or indirectly, by causing more severe illness, similar to other severe infections. 11 AKI may be more frequent and more severe (ie, more stage 3 AKI) in hospitalized patients with than without COVID-19, and is associated with 7 to 15 times higher mortality risk vs COVID-19 patients without AKI. [12][13][14][15] Furthermore, in patients without COVID-19, AKI that first occurs in the hospital (hospital-acquired AKI [HA-AKI]) is associated with higher mortality, 16 longer hospital length of stay (LOS), and higher costs 17 than community-acquired AKI (CA-AKI), which occurs prior to hospital admission.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes, Healthcare Resource Utilization, and Costs of Overall, Community-Acquired, and Hospital-Acquired Acute Kidney Injury in COVID-19 Patients

Koyner

Mackey

Rosenthal

et al. 2023

Journal of Health Economics and Outcomes Research

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Background: In hospitalized patients with COVID-19, acute kidney injury (AKI) is associated with higher mortality, but data are lacking on healthcare resource utilization (HRU) and costs related to AKI, community-acquired AKI (CA-AKI), and hospital-acquired AKI (HA-AKI). Objectives: To quantify the burden of AKI, CA-AKI, and HA-AKI among inpatients with COVID-19. Methods: This retrospective cohort study included inpatients with COVID-19 discharged from US hospitals in the Premier PINC AI™ Healthcare Database April 1–October 31, 2020, categorized as AKI, CA-AKI, HA-AKI, or no AKI by ICD-10-CM diagnosis codes. Outcomes were assessed during index (initial) hospitalization and 30 days postdischarge. Results: Among 208 583 COVID-19 inpatients, 30%, 25%, and 5% had AKI, CA-AKI, and HA-AKI, of whom 10%, 7%, and 23% received dialysis, respectively. Excess mortality, HRU, and costs were greater for HA-AKI than CA-AKI. In adjusted models, for patients with AKI vs no AKI and HA-AKI vs CA-AKI, odds ratios (ORs) (95% CI) were 3.70 (3.61-3.79) and 4.11 (3.92-4.31) for intensive care unit use and 3.52 (3.41-3.63) and 2.64 (2.52-2.78) for in-hospital mortality; mean length of stay (LOS) differences and LOS ratios (95% CI) were 1.8 days and 1.24 (1.23-1.25) and 5.1 days and 1.57 (1.54-1.59); and mean cost differences and cost ratios were $7163 and 1.35 (1.34-1.36) and $19 127 and 1.78 (1.75-1.81) (all P < .001). During the 30 days postdischarge, readmission LOS was ≥6% longer for AKI vs no AKI and HA-AKI vs CA-AKI; outpatient costs were ≥41% higher for HA-AKI vs CA-AKI or no AKI. Only 30-day new dialysis (among patients without index hospitalization dialysis) had similar odds for HA-AKI vs CA-AKI (2.37-2.8 times higher for AKI, HA-AKI, or CA-AKI vs no AKI). Discussion: Among inpatients with COVID-19, HA-AKI had higher excess mortality, HRU, and costs than CA-AKI. Other studies suggest that interventions to prevent HA-AKI could decrease excess morbidity, HRU, and costs among inpatients with COVID-19. Conclusions: In adjusted models among COVID-19 inpatients, AKI, especially HA-AKI, was associated with significantly higher mortality, HRU, and costs during index admission, and higher dialysis and longer readmission LOS during the 30 days postdischarge. These findings support implementation of interventions to prevent HA-AKI in COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes, Healthcare Resource Utilization, and Costs of Overall, Community-Acquired, and Hospital-Acquired Acute Kidney Injury in COVID-19 Patients

Koyner

Mackey

Rosenthal

et al. 2023

Journal of Health Economics and Outcomes Research

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“…The severity of AKI was also associated with mortality [ 24 ]. Similarly, the incidence of more severe AKI that requires renal-replacement therapy in an ICU appears to have declined over time: the data from England and Wales show that RRT declined from 26% at the start of the pandemic to 14% in 2022 [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Acute kidney injury (AKI) may be caused by many factors, including heart failure, sepsis, hemorrhage, nephro-toxic drugs, as well as by COVID-19. A recent review paper addressed COVID-19-associated AKI [ 5 ]. It is now widely believed that AKI is a frequent and significant complication of COVID-19; however, there is significant variability in its reported incidence and outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…In those infected with COVID-19, major observational studies and meta-analyses have reported AKI incidence rates of 28–34% in inpatients and 46–77% in those in the intensive care unit (ICU). Nevertheless, the prevalence of more severe cases of AKI that require RRT in the ICU appears to have reduced over time: the data from England and Wales show that RRT has declined from 26% at the start of the pandemic to 14% in 2022 [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Serum and Urinary Biomarkers in COVID-19 Patients with or without Baseline Chronic Kidney Disease

Filev

Lyubomirova

Hristova

et al. 2023

JPM

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In a prospective, observational, non-interventional, single-center study, we assessed various plasma and urinary biomarkers of kidney injury (neutrophil gelatinase-associated Lipocain [NGAL], kidney-injury molecule-1 [KIM-1], and interleukin-18 [IL-18]); inflammation (IL-6, C-reactive protein [CRP]); plus angiotensin converting enzyme 2 (ACE2) in 120 COVID-19 patients (of whom 70 had chronic kidney disease (CKD) at emergency-department (ED) admission). Our aim was to correlate the biomarkers with the outcomes (death, acute kidney injury [AKI]). All patients had received a chest-CT scan at admission to calculate the severity score (0–5). Biomarkers were also assessed in healthy volunteers and non-COVID-19-CKD patients. These biomarkers statistically differed across subgroups, i.e., they were significantly increased in COVID-19 patients, except for urinary (u)KIM1 and uIL-18. Amongst the biomarkers, only IL-6 was independently associated with mortality, along with AKI and not using remdesivir. Regarding the prediction of AKI, only IL-6 and uKIM1 were significantly elevated in patients presenting with AKI. However, AKI could not be predicted. Having high baseline IL-6 levels was associated with subsequent ventilation requirement and death. The mortality rate was almost 90% when the chest CT-scan severity score was 3 or 4 vs. 6.8% when the severity score was 0–2 (p < 0.0001).

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Long-term renal outcomes of patients with COVID-19: a meta-analysis of observational studies

Zhang,

Zhao,

Wang

et al. 2023

J Nephrol

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COVID-19-associated AKI

Cited by 21 publications

References 71 publications

Outcomes, Healthcare Resource Utilization, and Costs of Overall, Community-Acquired, and Hospital-Acquired Acute Kidney Injury in COVID-19 Patients

Outcomes, Healthcare Resource Utilization, and Costs of Overall, Community-Acquired, and Hospital-Acquired Acute Kidney Injury in COVID-19 Patients

Serum and Urinary Biomarkers in COVID-19 Patients with or without Baseline Chronic Kidney Disease

Long-term renal outcomes of patients with COVID-19: a meta-analysis of observational studies

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