Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Abstract

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

The response of Canada’s clinical health research ecosystem to the COVID-19 pandemic

“…As of Oct. 31, 2023, the main results of 12 of the 16 RCTs 20-28 (75%) and 4 of the 7 cohort studies [29][30][31][32][33] (57.1%) had been published. References and citation metrics appear in Appendix 1, Table S4.…”

Outcomes of COVID-19 patients with acute kidney injury and longitudinal analysis of laboratory markers during the hospital stay: A multi-center retrospective cohort experience from Pakistan

“…[ 30 , 31 ] However, in our cohort, we only found it associated with increasing age. Now concerning the presentation, Pitre et al [ 32 ] gave their aspect of 57.6% of patients presented with AKI to the hospital, while the rest 42.4% developed AKI during in-hospital stay. Furthermore, these in-hospital events can be attributed to the disease course, development of cytokine release storm, [ 33 ] or drug-induced renal injury related to COVID-19 therapy.…”

Factors Predictive of Development of Acute Kidney Injury in Patients With COVID-19 in Brunei Darussalam

“…A meta-analysis by Chan et al reported lower incidence in Chinese provinces like Guangdong (1.74%), Hong Kong (3.72%), and Hubei (4.25%), but very high in American states like Michigan (44.73%), New York (33.07%) and Pennsylvania (49.33%) [ 17 ]. Similarly, other Western Pacific nations like Singapore (8.1%) and South Korea (4.0%) also reported low rates [ 4 , 18 ], compared to Middle Eastern countries (Iran 37.6%, Bahrain 47.6%) [ 19 , 20 ], Europe (Italy 22%, UK 29%, Turkey 54%, Portugal 55%) [ 21 - 24 ] and the Americas (USA 33-49%, Brazil 71%, Canada 54%) [ 6 , 7 , 25 , 26 ]. The wide discrepancies are likely related to dissimilarities in handling the pandemic through different screening and admission policies, healthcare disparities, hospital capacity, surveillance systems, social determinants, and disease epidemiology.…”