Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19

Abstract

Acute kidney injury (AKI) is associated with high mortality in coronavirus disease 2019 (COVID-19). However, it is unclear whether patients with COVID-19 with hospital-acquired AKI (HA-AKI) and community-acquired AKI (CA-AKI) differ in disease course and outcomes. This study investigated the clinical profiles of HA-AKI, CA-AKI, and no AKI in patients with COVID-19 at a large tertiary care hospital in the New York City area. The incidence of HA-AKI was 23.26%, and CA-AKI was 22.28%. Patients who developed HA-AKI were older and had more comorbidities compared to those with CA-AKI and those with no AKI (p < 0.05). A higher prevalence of coronary artery disease, heart failure, and chronic kidney disease was observed in those with HA-AKI compared to those with CA-AKI (p < 0.05). Patients with CA-AKI received more invasive and non-invasive mechanical ventilation, anticoagulants, and steroids compared to those with HA-AKI (p < 0.05), but patients with HA-AKI had significantly higher mortality compared to those with CA-AKI after adjusting for demographics and clinical comorbidities (adjusted odds ratio = 1.61, 95% confidence interval = 1.1–2.35, p < 0.014). In addition, those with HA-AKI had higher markers of inflammation and more liver injury (p < 0.05) compared to those with CA-AKI. These results suggest that HA-AKI is likely part of systemic multiorgan damage and that kidney injury contributes to worse outcomes. These findings provide insights that could lead to better management of COVID-19 patients in time-sensitive and potentially resource-constrained environments.

Outcomes of Hospitalized Patients With COVID-19 With Acute Kidney Injury and Acute Cardiac Injury

“…AKI was defined using the Kidney Disease Improving Global Outcomes criteria as either a 0.3 mg/dl increase in serum creatinine within 48 h or a 1.5x increase in serum creatinine within a 7-day iterative window. The baseline creatinine was determined as the mean of all serum creatinine values 8–365 days preceding hospitalization ( 20 , 21 , 29 ). For patients who did not have creatinine baseline values, the lowest creatinine value during hospitalization was used as the baseline creatinine ( 19 , 30 ).…”

“…The heart may be more susceptible to early damage than other organs as heart muscle has a high density of ACE2 receptors (4,39). The early ACI onset suggests that ACI is a primary effect of COVID-19, whereas AKI (20,21) and acute liver injury (40) occur later in the COVID-19 clinical disease course and with more distributed onsets, suggesting that AKI and acute liver injury may arise from secondary effects of COVID-19 (i.e., systemic hypoxia, hypotension, shock, sepsis, and cytokine storm) and/or COVID-19 treatments (6,7). These secondary effects could also contribute to sustained ACI (41)(42)(43).…”

“…Observational studies have characterized the risk factors and outcomes of AKI (16)(17)(18)(19)(20)(21) and ACI (22)(23)(24)(25) separately among hospitalized patients with COVID-19. However, there have been no systematic studies comparing outcomes of COVID-19 patients with AKI to COVID-19 patients with ACI or evaluating the incidence, risk factors and clinical outcomes of COVID-19 patients who develop both AKI and ACI during hospitalization.…”

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

“…While studies have indicated that a change in urine flow rate can be detected earlier with frequent observations than measuring sCr, the UO criteria may only have value in hospitalized patients. However, this diagnostic criterion based on UO is sometimes unreported in studies [ 44 , 50 ], and has wide variation and inconsistency on how one monitors and measures UO [ 22 , 51 , 52 ]. For example, hourly monitoring performed visually with manual recording can be time consuming for nurses, who may check only when the collection bags need emptying, for example at 6 h [ 49 , 51 ].…”

“…<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.…”