Hypertension Is a Risk Factor for Acute Kidney Injury and a Predictor of Mortality in Hospitalized Patients With Covid-19

Abstract

Objective: Initial reports indicate a high incidence of acute kidney injury(AKI) in the novel coronavirus infection (COVID-19). Hypertension(HTN) frequently coexists with COVID-19 and may be a possible risk factor for AKI. The aim of the study was to investigate the contribution of HTN for the AKI development in patients hospitalized with COVID-19. Design and method: A retrospective analysis of the register of patients with COVID-19 was performed. COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical CT picture. AKI definition was based on KDIGO criteria. P value < 0.05 was considered statistically significant. Results: The register included 721 patients(49.6% male, age 64 ± 15.7 years, HTN in 66%, controlled in 80%, obesity in 50.8%, diabetes mellitus(DM) in 24.2%, chronic kidney disease(CKD) in 6%). The median length of stay was 11[9;15] days, in the ICU – 4[2;9] days. 18.9% of patients died. Mean blood pressure at admission was 130 ± 17/80 ± 11 mmHg in the hypertensive group. 40.3% of patients received angiotensin-converting enzyme inhibitors(ACEi) or angiotensin II-receptors blockers(ARBs) regularly before admission. In 79% therapy was continued, in 21% - withdrawn. The AKI incidence in the register was 27.2%, in hypertensive patients– 30.1%. ACEi /ARBs intake wasn‘t associated with AKI. Hypertensive patients compared to normotensives were older (69 ± 12vs50 ± 15, p < 0.0001), more often had DM (31.7%vs10%, p < 0.0001), CKD (8%vs2%, p = 0.01). History of HTN was associated with higher mortality (23.6%vs10.7%, p = 0.001). HTN incidence was higher in patients with AKI (80%vs61%, p < 0.0001) and HTN was a risk factor for AKI development (OR 2.45, 95% CI 1.49–4.13, p = 0.0002). Hypertensive patients with AKI compared to patients without AKI had longer duration of hospitalization (13 ± 7vs12 ± 6 days, p = 0.003), were more likely to be treated with mechanical ventilation (50%vs13%, p < 0.0001), more often were in the ICU (46.5%vs16.4%, p < 0.001 and had higher in-hospital mortality (48%vs9.7%, respectively, p < 0.0001).The AKI development and history of HTN were predictors of mortality: OR 8.90 (95%CI 5.7–13.78, p < 0.0001) and OR 2.58 (95%CI 1.46–4.75, p = 0.0006), respectively. Conclusions: AKI is common among patients hospitalized with COVID-19 and is associated with the presence of HTN. HTN and AKI development are the significant predictors of in-hospital mortality in this population.