Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

Abstract

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients.

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

“…It is regarded as a common complication of COVID-19 and it can develop independently of baseline kidney function [ 7 , 9 , 35 ]. However, kidney impairment has been recognized as a risk factor for AKI [ 9 , 16 ]. Other risk factors for AKI in COVID-19 patients include diabetes mellitus, hypertension, male gender, the need for ventilation support, and high interleukin-6 levels [ 10 , 50 ].…”

“…It is well known that AKI is associated with worse outcomes regardless of its etiology [ 13 , 14 , 15 ]. In the case of the current COVID-19 pandemic, the available data indicate a strong association between AKI and mortality [ 16 , 17 , 18 ]. Hirsch et al reported mortality of 35% for patients with AKI compared to 6% in those without AKI [ 10 ].…”

Urinary SARS-CoV-2 RNA Is an Indicator for the Progression and Prognosis of COVID-19

“…The involvement of kidneys is usually evaluated in two aspects of renal functional impairment and renal insult. AKI has been reported as a severe complication of COVID-19 and it is associated with a heightened risk of mortality [37,38]. The reported incidence of AKI among hospitalized patients with COVID-19 varies widely, with ranges from 19-62.3% [18,38,39].…”

“…AKI has been reported as a severe complication of COVID-19 and it is associated with a heightened risk of mortality [37,38]. The reported incidence of AKI among hospitalized patients with COVID-19 varies widely, with ranges from 19-62.3% [18,38,39]. Chan et al found that incidence for the patients admitted to ICU with AKI was up to 76% [40].…”

Mechanisms of SARS-CoV-2 Infection-Induced Kidney Injury: A Literature Review

“…We performed a systematic search in PubMed to identify recently published large cohort studies related to AKI in patients with COVID-19. We used the search terms “Coronavirus”, “COVID-19”, “SARS-CoV-2”, “acute kidney damage”, “acute kidney injury”, “AKI” and found that the incidence of AKI was higher in severe COVID-19 patients and AKI was strongly associated with high mortality ( Table 1 ) ( Bell et al., 2021 ; Chen et al., 2021 ; Jewell et al., 2021 ; Kilis‐pstrusinska et al., 2021 ; Marques et al., 2021 ; Procaccini et al., 2021 ; Rahimzadeh et al., 2021 ; Scarpioni et al., 2021 ; Sullivan et al., 2021 ; Strohbehn et al., 2021 ; Wan et al., 2021 ; Hung et al., 2022 ; Hsu et al., 2022 ; Sindhu et al., 2022 ). Many possible mechanisms for COVID-19-induced kidney injury have been proposed, including the direct kidney injury mediated by the combination of virus and ACE2.…”