Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study

Abstract

Background There are limited data on acute kidney injury (AKI) progression and long-term outcomes in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to describe the prevalence and risk factors for development of AKI, its subsequent clinical course and AKI progression, as well as renal recovery or dialysis dependence and survival in this group of patients. Methods This was a retrospective observational study in an expanded tertiary care intensive care unit in London, United Kingdom. Critically ill patients admitted to ICU between 1st March 2020 and 31st July 2020 with confirmed SARS-COV2 infection were included. Analysis of baseline characteristics, organ support, COVID-19 associated therapies and their association with mortality and outcomes at 90 days was performed. Results Of 313 patients (70% male, mean age 54.5 ± 13.9 years), 240 (76.7%) developed AKI within 14 days after ICU admission: 63 (20.1%) stage 1, 41 (13.1%) stage 2, 136 (43.5%) stage 3. 113 (36.1%) patients presented with AKI on ICU admission. Progression to AKI stage 2/3 occurred in 36%. Risk factors for AKI progression were mechanical ventilation [HR (hazard ratio) 4.11; 95% confidence interval (CI) 1.61–10.49] and positive fluid balance [HR 1.21 (95% CI 1.11–1.31)], while steroid therapy was associated with a reduction in AKI progression (HR 0.73 [95% CI 0.55–0.97]). Kidney replacement therapy (KRT) was initiated in 31.9%. AKI patients had a higher 90-day mortality than non-AKI patients (34% vs. 14%; p < 0.001). Dialysis dependence was 5% at hospital discharge and 4% at 90 days. Renal recovery was identified in 81.6% of survivors at discharge and in 90.9% at 90 days. At 3 months, 16% of all AKI survivors had chronic kidney disease (CKD); among those without renal recovery, the CKD incidence was 44%. Conclusions During the first COVID-19 wave, AKI was highly prevalent among severely ill COVID-19 patients with a third progressing to severe AKI requiring KRT. The risk of developing CKD was high. This study identifies factors modifying AKI progression, including a potentially protective effect of steroid therapy. Recognition of risk factors and monitoring of renal function post-discharge might help guide future practice and follow-up management strategies. Trial registration NCT04445259

Acute Kidney Injury among Hospital-Admitted COVID-19 Patients: A Study from Jordan

“…In concordance, this was also reported by a UK study. 35 Although decreased mortality with remdesivir was not found, it decreased the incidence of AKI. 36 …”

Kidney Recovery and Death in Critically Ill Patients With COVID-19–Associated Acute Kidney Injury Treated With Dialysis: The STOP-COVID Cohort Study

“…Interestingly, the same analysis suggested an association between steroid use and kidney recovery, though it did not reach statistical significance, and in a separate recent study, steroid use was associated with reduced risk for AKI progression. 19 The observed association of steroid use with better kidney outcomes should be more systematically explored in subsequent larger clinical/epidemiologic investigations. Tocilizumab and remdesivir, which are also both now used more widely than during the study period, were not significantly associated with either kidney or mortality outcomes in this study.…”

“…Compared to prior studies of AKI-KRT among critically ill patients without COVID-19, this study and other studies of patients with COVID-19 have found higher rates of in-hospital mortality and of dialysis dependence at hospital discharge. 1 , 8 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 These differences in outcomes may reflect the profound multiorgan failure associated with COVID-19 during the initial spring 2020 surge. The higher rate of kidney non-recovery may also be due to direct infection of the kidneys by the SARS-CoV-2 virus, though this remains controversial.…”

Insuficiencia renal y hemodiálisis en pacientes hospitalizados con COVID-19 durante la primera ola en Lima, Perú

“…La IRA en pacientes hospitalizados con COVID-19 también aumenta el riesgo de desenlaces clínicos negativos [17] . Finalmente, la ERC puede desarrollarse en los meses posteriores al alta en los sobrevivientes a un IRA durante su hospitalización [18,19] . Entonces, el IRA o ERC causan un mayor riesgo de tener desenlaces clínicos negativos en comparación con los pacientes con función renal normal [20][21][22] .…”