Impact of hospital-acquired acute kidney injury on Covid-19 outcomes in patients with and without chronic kidney disease: a multicenter retrospective cohort study

Abstract

Background/aim Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods HA-AKI development was assessed in a group of stage 3–5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results Among 621 hospitalized patients (age 60 [IQR: 47–73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9–44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9–33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.

Kidney Dysfunction and Its Progression in Patients Hospitalized Duo to COVID-19: Contribution to the Clinical Course and Outcomes

“…In the group of patients with eGFR ≥ 60 mL/min/1.73 m 2 , the rates were 23.25% and 9.64% ( p < 0.001), respectively. Our results are consistent with observations made by other authors [ 18 , 34 , 35 , 36 ]. In a UK population-based cohort study, increased risk of death was evident from eGFR 45–59 mL/min/1.73 m 2 in people with type 1 and type 2 diabetes [ 37 ].…”

“…It is believed that there is a correlation between renal function impairment and increased risk of death in patients with COVID-19 [ 20 , 33 , 34 , 35 ]. In this study of nearly 2000 adults with COVID-19, we found that the mortality rate during hospitalization was much higher in patients with eGFR < 60 mL/min/1.73 m 2 than in patients with eGFR ≥ 60 mL/min/1.73 m 2 at admission (29.38% vs. 10.36%, respectively; p < 0.001).…”

Follow‐up of renal transplant recipients after acute COVID‐19—A prospective cohort single‐center study

“… 1 Preexistent chronic renal disease was identified as a risk factor for acute kidney injury during the hospital stay. 34 , 35 , 36 , 37 We have also demonstrated that impaired renal allograft function presents a risk factor for developing post‐COVID‐19 complications in general. All except one patient with acute allograft dysfunction and/or development of proteinuria already had chronic allograft dysfunction.…”

Impact of the COVID-19 pandemic on interest in renal diseases

“…Interestingly, RSV values for the terms “amyloidosis” and “acute kidney injury” were increased compared to the previous 4 years in both time intervals. We cannot explain this increase for the term “amyloidosis.” However, various studies have reported that the incidence of AKI in patients with COVID-19 is between 3 and 15% and this is associated with increased mortality (Zhou et al 2020 ; Sİpahİ et al 2020 ; Adapa et al 2020 ; Öztürk et al 2021 ). Also, AKI rates are 14.5–50% in patients with severe COVID-19 infection in the intensive care unit (Zhou et al 2020 ; Sİpahİ et al 2020 ; Adapa et al 2020 ; Öztürk et al 2021 ; Dirim et al 2021 ).…”

“…However, various studies have reported that the incidence of AKI in patients with COVID-19 is between 3 and 15% and this is associated with increased mortality (Zhou et al 2020;Sİpahİ et al 2020;Adapa et al 2020;Öztürk et al 2021). Also, AKI rates are 14.5-50% in patients with severe COVID-19 infection in the intensive care unit (Zhou et al 2020;Sİpahİ et al 2020;Adapa et al 2020;Öztürk et al 2021;Dirim et al 2021). As this condition is known to be associated with COVID-19 since the early stage of the pandemic, the initial increase in RSV for search query "acute kidney injury" is not unexpected.…”