Progression to CKD After COVID-19-Related AKI

Patients with acute kidney injury (AKI) are at risk of progression to chronic kidney disease (CKD) and end-stage renal disease (ESRD). AKI is a common complication associated with COVID-19. Thiago Terzian Ganadjian, MD, and colleagues at Universidade Federal Sao Paulo, Sao Paulo, Brazil, conducted a study to examine the frequency and association of clinical variables in patients who developed CKD and ESRD following AKI related to COVID-19.

The researchers reported results of the 1-year follow-up study during a poster session at the American Society of Nephrology Kidney Week 2022. The poster was titled The Emergence of CKD After COVID-19 Related AKI.

The study included 182 survivor patients who were admitted to the center’s ward and intensive care unit with COVID-19 between April 2020 and March 2021. Inclusion criteria were age ≥18 years and COVID-19 confirmed on reverse transcription-polymerase chain reaction test. Exclusion criteria included ESRD prior to hospitalization.

Kidney Disease: Improving Global Outcomes criteria were used to define AKI and CKD. The researchers assessed the frequency of AKI and then compared selected clinical variables in two subgroups: CKD after COVID-19-related AKI and non-CKD after COVID-19. Univariate and multivariate analyses were conducted.

A total of 137 patients (75.3%) developed AKI. Of those, 30.8% (n=56) required renal replacement therapy (RRT) in hospital. In the CKD after COVID-19-related AKI group, there were higher frequencies of diabetes and hypertension with lower estimated glomerular filtration rate (84.2 mL/min/1.73 m2 vs 94.4 mL/min/1.73 m2; P=.08) and mean arterial pressure at baseline (74.9 mm Hg vs 79.1 mm Hg; P=.03).

In binary logistic regression, there was an independent association between hypertension and CKD (odds ratio, 4.472; 95% CI, 1.356-13.886; P=.001). All patients who progressed to ESRD (3.9%, n=7) had nondialytic CKD exacerbated by COVID-19 requiring RRT.

“Hypertension was the independent clinical factor associated with progression to CKD after COVID-19-related AKI. All patients who progressed to ESRD had CKD exacerbated by COVID-19 requiring RRT,” the authors said.

Source: Terizan Ganadjian T, Nakamura PL, Silva BM. The emergence of CKD after COVID-19 related AKI. TH-PO904. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 3, 2022; Orlando, Florida.