Acute kidney injury in hospitalized patients with COVID-19: A Portuguese cohort

Gameiro, Joana; Fonseca, José Agapito; Oliveira, João; Marques, Filipe; Bernardo, João; Costa, Cláudia; Carreiro, Carolina; Bráz, Sandra; Lopes, José António

doi:10.1016/j.nefroe.2022.01.007

Cited by 5 publications

(4 citation statements)

References 44 publications

(58 reference statements)

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“…These findings concur with other reports indicating age as an independent predictor for AKI [14,36,37]. Furthermore, age has also been reported as a risk factor for death in COVID-19 patients [19,38], suggesting that elderly population is at a higher risk of morbidity and mortality, warranting special attention upon admission. In addition, similar to our study cohort, a retrospective study in London demonstrated a three-fold risk of AKI for patients who developed COVID-19 AKI with pre-existing CKD [16].…”

Section: Discussionsupporting

confidence: 91%

“…In our study, the classification of AKI severity is based on KDIGO criteria 2012. We noted that most hospitalized patients who developed AKI predominantly fell into stage 1 (77%), which is in keeping with findings from most other studies indicating stage 1 AKI was the commonest occurrence [14,[19][20][21]. Severe AKI (stage 2 or 3) was more prevailing in critically ill patients who needed intensive care [22,23] and it was associated with higher mortality.…”

Section: Discussionsupporting

confidence: 87%

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A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country

Ooi,

Ng,

Sthaneshwar

et al. 2024

BMC Nephrol

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Background The commonest indication for hospitalization in COVID-19 patients is hypoxemia or severe respiratory symptoms. However, COVID-19 disease may result in extrapulmonary complications including kidney-related pathology. The reported incidence of renal involvement related to COVID infection varies based on geographical location. Objective This study aimed to assess the incidence rate of AKI in hospitalized COVID-19 patients and identify risk factors and prognostic predictors. Method In this retrospective study, we recruited hospitalized COVID-19 patients from January 2021 until June 2021 at the University Malaya Medical Center. The inclusion criteria were hospitalized for ≥ 48 h with confirmed COVID-19 infection and at least 18 years old. Patient demographic and clinical data were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines. Results One thousand five hundred twenty-nine COVID patients fulfilled the inclusion criteria with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36–66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n = 85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n = 323). The percentage of COVID patients in different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. Fifteen hospitalized patients (0.98%) required renal replacement therapy. 58.8% (n = 190) of AKI group had complete recovery of kidney function. Demographic factors included age (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.012), CKD (p < 0.001), and vaccination status (p = 0.042) were associated with an increased risk of developing AKI. We found that the AKI cohort had statistically significant lower platelet counts and higher ferritin levels than the non-AKI cohort. AKI is a risk predictor of prolonged hospitalization (p < 0.001) and higher mortality rates (P < 0.001). Conclusion AKI is a common clinical complication among hospitalized COVID-19 patients. The etiology of AKI is multifactorial and may have an adverse impact on patient morbidity and mortality.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country

Ooi,

Ng,

Sthaneshwar

et al. 2024

BMC Nephrol

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“…[5] The frequency of acute kidney injury (AKI) in COVID-19 patients goes from 0.5% to 35% and has been related to worse prognosis. [6] TMPRSS2 (trans-membrane serine protease) and ACE2 (Angiotensin-converting enzyme 2) are fundamentally liable for the entry of SARS-COV-2 into various kidney cell types affecting renal function. [7] AKI is common among hospitalized patients with COVID-19, particularly the ones under critical care.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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The frequency of acute kidney injury (AKI) in COVID-19 patients can be varied and related to worse outcomes in the disease population. AKI is common among hospitalized patients with COVID-19, particularly the ones needing critical care. This study was conducted in order to determine the outcomes of hospitalized patients with prolonged hospital stays who suffered from COVID-19 associated AKI. It was conducted as a multi-centered, retrospective, cohort study, and including all patients who were diagnosed on COVID-19 PCR. End-stage renal disease patients on hemodialysis were excluded. The cohort included 1069 patients, with 68% males, mean age of 56.21 years, and majority within 50 to 75 years age group (60%). Mean disease onset was 14.43 ± 7.44 days and hospital stay was 7.01 ± 5.78 days. About 62% of patients stayed in intensive care and 18% of them were on invasive ventilation. The mortality rate was 27%. Frequency of AKI was 42%, around 14% of them were resolving during hospital stay and other 28% worsened. The mortality rate was significantly higher with AKI (OR: 4.7, P < .001). Alongside AKI, concomitant liver dysfunction was also significantly contributing to mortality (OR: 2.5), apart from ICU stay (OR: 2.9), invasive ventilation (OR: 9.2), and renal replacement therapy (OR: 2.4). Certain laboratory markers were associated with AKI throughout in-hospital stay.

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“…1,2 During the COVID-19 pandemic in the United States, AKI incidence was highly variable. 1,[3][4][5] While the rates of AKI have decreased and even have overall less severity during vaccination, it is still a significant complication. 6,7 However, the molecular pathophysiology of AKI in COVID-19 is unclear.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Transcriptomics in Acute and Long-Term Kidney Dysfunction in SARS-CoV2 Infection

Jayaraman,

Rajagopal,

Paranjpe

et al. 2023

Preprint

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Background. Acute kidney injury (AKI) is common in hospitalized patients with SARS-CoV2 infection despite vaccination and leads to long-term kidney dysfunction. However, peripheral blood molecular signatures in AKI from COVID-19 and their association with long-term kidney dysfunction are yet unexplored. Methods. In patients hospitalized with SARS-CoV2, we performed bulk RNA sequencing using peripheral blood mononuclear cells (PBMCs). We applied linear models accounting for technical and biological variability on RNA-Seq data accounting for false discovery rate (FDR) and compared the functional enrichment and pathway results to a historical sepsis-AKI cohort. Finally, we evaluated the association of these signatures with long-term trends in kidney function. Results. Of 283 patients, 106 had AKI. After adjustment for sex, age, mechanical ventilation, and chronic kidney disease (CKD), we identified 2635 significant differential gene expressions at FDR<0.05. Top canonical pathways were EIF2 signaling, oxidative phosphorylation, mTOR signaling, and Th17 signaling, indicating mitochondrial dysfunction and endoplasmic reticulum (ER) stress. Comparison with sepsis associated AKI showed considerable overlap of key pathways (48.14%). Using follow-up estimated glomerular filtration rate (eGFR) measurements from 115 patients, we found that 164/2635 (6.2%) of the significantly differentiated genes were associated with overall decrease in long-term kidney function. The strongest associations were autophagy, renal impairment via fibrosis and cardiac structure/function. Conclusions. We show that AKI in SARS-CoV2 is a multifactorial process with mitochondrial dysfunction driven by ER stress whereas long-term kidney function decline is associated with cardiac structure and function, and immune dysregulation. Functional overlap with sepsis-AKI also highlights common signatures indicating generalizability in therapeutic approaches.

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Acute kidney injury in hospitalized patients with COVID-19: A Portuguese cohort

Cited by 5 publications

References 44 publications

A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country

A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country

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

Peripheral Transcriptomics in Acute and Long-Term Kidney Dysfunction in SARS-CoV2 Infection

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