COVID-19−Associated Acute Kidney Injury and Longitudinal Kidney Outcomes

Abstract

ImportanceCOVID-19 infection is associated with a high incidence of acute kidney injury (AKI). Although rapid kidney function decline has been reported in the first few months after COVID-19−associated AKI (COVID-AKI), the longer-term association of COVID-AKI with kidney function remains unknown.ObjectiveTo assess long-term kidney outcomes of patients who had COVID-19−associated AKI.Design, Setting, and ParticipantsThis was a retrospective longitudinal multicenter cohort study conducted in a large hospital system using electronic health records data on adult hospitalized patients with AKI and COVID-19 or other illnesses. Included patients were hospitalized during the COVID-19 pandemic (March 2020-June 2022), were screened for SARS-CoV-2, had AKI, and survived to discharge, or had been hospitalized during the 5 years before the pandemic (October 2016-January 2020), had a positive influenza A or B test result, had AKI, and survived to discharge. Patients were followed up for a maximum of 2 years after hospital discharge. Data analyses were performed from December 2022 to November 2023.ExposureCOVID-19 and influenza.Main Outcomes and MeasuresThe primary outcome was major adverse kidney events (MAKE), defined as a composite of mortality and worsened kidney function (estimated glomerular filtration rate [eGFR] decline by ≥25% from discharge eGFR or kidney failure requiring dialysis). Multivariable time-to-event analyses were performed to compare MAKE between individuals with COVID-AKI and those who had AKI associated with other illnesses hospitalized during the same period. For further comparison, this outcome was assessed for a historic cohort of patients with influenza-associated AKI.ResultsThe study cohort included 9624 hospitalized patients (mean [SD] age, 69.0 [15.7] years; 4955 [51.5%] females) with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI associated with other illnesses (other-AKI). Compared with the other 2 groups, patients with COVID-19−associated AKI were slightly younger in age, had a higher baseline eGFR, worse baseline comorbidity scores, higher markers of illness severity, and longer hospital stay. Compared with the other-AKI group, the COVID-AKI group had lower MAKE (adjusted hazard ratio [aHR], 0.67; 95% CI, 0.59-0.75) due to lower all-cause mortality (aHR, 0.31; 95% CI, 0.24-0.39) and lower rates of worsened kidney function (aHR, 0.78; 95% CI, 0.69-0.88).Conclusions and RelevanceThe findings of this multicenter cohort study indicate that survivors of hospitalization with COVID-AKI experience lower rates of MAKE, long-term kidney function decline, and mortality compared with patients with AKI associated with other illnesses.

Exploring therapeutic mechanisms of Chuan Huang Fang-II in the treatment of acute kidney injury on chronic kidney disease patients from the perspective of lipidomics

“…Reasons why the cause of CKD are not different from elsewhere in the world might as follows: The clinical trial was conducted during the COVID-19 pandemic period when many patients, especially older patients, couldn’t have access to effective medical treatments. According to published data, numerous studies [ 20–22 ] have reported COVID-19 infection is associated with a high incidence of AKI or A on C; In addition, the limited number of patients (98 cases) included in this clinical trial also had a certain impact on the results; Besides, the influence of regional reasons also has a certain relationship. The presence of CKD poses a threat to kidney function and delays the recovery of kidney function in patients with AKI.…”

Are Kidneys Affected by SARS-CoV-2 Infection? An Updated Review on COVID-19-Associated AKI

“…It has been discussed that the biochemistry of kidney tubular injury plays a pivotal role in the pathogenesis of long COVID [ 52 ]. Recently, a multicenter cohort study ( n = 9624 patients) concluded that survivors of hospitalization with AKI-associated COVID-19 experienced a 33% lower risk of major adverse kidney events and 69% lower risk of mortality in comparison with AKI related to influenza or other illnesses [ 53 ]. Patients were followed up for a maximum of 2 years after hospital discharge.…”

Kidney Function Tests and Continuous eGFR Decrease at Six Months after SARS-CoV-2 Infection in Patients Clinically Diagnosed with Post-COVID Syndrome

“…Akliu et al's research [31] demonstrated a notable decrease in major adverse kidney events (MAKE) among patients with COVID-19-associated AKI, with an adjusted hazard ratio for MAKE of 0.67, indicating a significantly lower risk when compared to AKI from other illnesses. This was further supported by a marked reduction in all-cause mortality, with an adjusted hazard ratio (aHR) of 0.31, and a lower rate of worsened kidney function (aHR, 0.78) in the COVID-AKI group.…”