Risk factors, clinical characteristics and prognostic value of acute kidney injury in COVID-19 compared with influenza virus and respiratory syncytial virus

Abstract

Background Acute Kidney Injury (AKI) complicates a substantial part of patients with COVID-19. Direct viral penetration of renal cells through the Angiotensin Converting Enzyme 2 receptor, and indirect damage by the aberrant inflammatory response characteristic of COVID-19 are likely mechanisms. Nevertheless, other common respiratory viruses such as Influenza and Respiratory Syncytial Virus (RSV) are also associated with AKI. Methods We retrospectively compared the incidence, risk factors and outcomes of AKI among patients who were admitted to a tertiary hospital because of infection with COVID-19, influenza (A + B) or RSV. Results We collected data of 2593 patients hospitalized with COVID-19, 2041 patients with influenza and 429 with RSV. Patients affected by RSV were older, had more comorbidities and presented with higher rates of AKI at admission and within 7 days (11.7% vs. 13.3% vs. 18% for COVID-19, influenza and RSV, respectively p = 0.001). Nevertheless, patients hospitalized with COVID-19 had higher mortality (18% with COVID-19 vs. 8.6% and 13.5% for influenza and RSV, respectively P < 0.001) and higher need of mechanical ventilation (12.4% vs. 6.5% vs.8.2% for COVID-19, influenza and RSV, respectively, P = 0.002). High ferritin levels and low oxygen saturation were independent risk factors for severe AKI only in the COVID-19 group. AKI in the first 48 h of admission and in the first 7 days of hospitalization were strong independent risk factors for adverse outcome in all groups. Conclusion Despite many reports of direct kidney injury by SARS-COV-2, AKI was less in patients with COVID-19 compared to influenza and RSV patients. AKI was a prognostic marker for adverse outcome across all viruses. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40620-023-01591-2.

Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis

“…All studies were retrospective cohort studies. Five studies were conducted in the United States ( 18 , 19 , 21 , 23 , 24 ), two in China ( 27 , 29 ), one in France ( 20 ), one in Austria ( 22 ), one in Turkey ( 25 ), one in Israel ( 26 ), and one in Pakistan ( 28 ). Eight studies ( 18 , 19 , 22–24 , 26 , 28 , 29 ) reported data on general hospitalized patients, and four studies reported data on critically ill patients in ICUs ( 20 , 21 , 25 , 27 ) and patients with ARDS requiring veno-venous ECMO ( 20 ).…”

“…Five studies were conducted in the United States ( 18 , 19 , 21 , 23 , 24 ), two in China ( 27 , 29 ), one in France ( 20 ), one in Austria ( 22 ), one in Turkey ( 25 ), one in Israel ( 26 ), and one in Pakistan ( 28 ). Eight studies ( 18 , 19 , 22–24 , 26 , 28 , 29 ) reported data on general hospitalized patients, and four studies reported data on critically ill patients in ICUs ( 20 , 21 , 25 , 27 ) and patients with ARDS requiring veno-venous ECMO ( 20 ). Three studies ( 27–29 ) enrolled patients with H1N1 (subtype of influenza A), six studies ( 20–24 , 26 ) enrolled patients with type A or B influenza, while the other four studies ( 18 , 19 , 24 , 25 ) recruited influenza patients without mentioning the subtype.…”

“…Eight studies ( 18 , 19 , 22–24 , 26 , 28 , 29 ) reported data on general hospitalized patients, and four studies reported data on critically ill patients in ICUs ( 20 , 21 , 25 , 27 ) and patients with ARDS requiring veno-venous ECMO ( 20 ). Three studies ( 27–29 ) enrolled patients with H1N1 (subtype of influenza A), six studies ( 20–24 , 26 ) enrolled patients with type A or B influenza, while the other four studies ( 18 , 19 , 24 , 25 ) recruited influenza patients without mentioning the subtype. The meta-analysis included 8,634 patients with COVID-19 and 8,984 patients with influenza.…”

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

“…In addition to demographic information, Table 1 [4][5][6][7][8][9][10][11][12] days; other-AKI, 6 [4][5][6][7][8][9][10][11][12] days; P < .001). The COVID-AKI group also had the largest weight loss at the time of discharge with a median (IQR) of −1.9 (−6.2 to 0.5) kg compared with −0.9 (−3.6 to 1.0) kg for the flu-AKI group and −0.4 (−3.9 to 1.7) kg for the other-AKI group.…”

“…[1][2][3][4] Although similar incidence of AKI is reported for patients hospitalized with COVID-19 and other respiratory viral illnesses, such as influenza, 5 COVID-19 has been associated with more severe AKI, higher incident chronic kidney disease (CKD), and higher mortality. [6][7][8] COVID-19 has also been associated with a range of functionally limiting long-term sequelae, even among individuals not requiring hospitalization. 9 Therefore, in addition to the acute adverse effects of COVID-19 on kidney function, there is a growing concern for prolonged adverse effects.…”