AKI in COVID-19 in Patients with and without prior Renal Dysfunction

The incidence rate of renal injury in patients with COVID-19 ranges from 3% to 9% and includes patients with urinary abnormalities to patients in critical care with acute kidney injury (AKI). The primary risk factors for COVID-19-related AKI are oncologic disease, sepsis, and heart failure. According to Carlos Guido Musso, MD, PhD, and colleagues, there are few data available on differences in AKI in patients with COVID-19 with previously healthy kidneys and those with chronic kidney disease (CKD).

The researchers conducted an analysis of data on patients who were treated during the first pandemic wave (2020) in Clinica de la Costa, Barranquilla, Columbia. Results of the analysis were reported during a virtual poster session at ASN Kidney Week 2021 in a poster titled AKI Associated with COVID-19: Differences Between Previously Healthy Kidney Individuals and CKD Patients.

The analysis included 572 patients with a diagnosis of COVID-19 confirmed by PCR test. Of the 572 patients, 188 developed AKI and had epidemiological data, serum parameters, and functional status recorded. Statistical analysis and comparison of previously kidney healthy patients with patients with previous CKD were performed.

Of 720 individuals evaluated in the emergency department for suspicion of COVID-19, 572 were admitted with confirmed SARS-CoV-2 infection. Of the 572 admitted patients, 59% were male, median age was 55 years, 36% had hypertension, 23% were obese, 18% had diabetes, 5% had heart disease, and 9% had chronic obstructive pulmonary disease (COPD). Nearly all patients (97%) were robust.

A total of 188 patients with COVID-19 developed AKI (33%). Of those, 26% (n=149) had a previous normal renal function and 7% (n=39) had CKD. Most of the patients with CKD (91%) developed AKI.

In the AKI group (both those with prior kidney health and those with CKD) , there was a greater percentage of men, participants older than 60 years, participants with Clinical Frailty Scale score ≥4, and those with diabetes mellitus, obesity, and COPD in comparison with the group without AKI. Compared with patients with prior kidney health, those with CKD had significantly higher prevalence of hypertension and cardiac disease. The prevalence of hypertension and heart disease in all patients with AKI was higher than in those without AKI.

There was a tendency of higher mortality rate in patients with prior kidney health than in those with CKD (69% vs 56%). That trend did not reach statistical significance. The trend toward higher mortality in patients with AKI compared with patients without AKI was statistically significant (P<.0001). D-dimer was significantly higher in patients with AKI with prior kidney health compared with patients with AKI with CKD (P=.06).

There was a trend to higher mortality rate and D-dimer levels in patients with AKI with prior normal renal function compared with patients with AKI and prior CKD, the authors summarized.

Source: Musso CG, Martinez A, Avendaño-Echavez, LG, et al. AKI associated with COVID-19: Differences between previously health kidney individuals and CKD patients. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2021 (Abstract PO0017), November 2021.