While COVID-19 is recognized as a typical syndrome of acute respiratory illness, it can also affect multiple organ systems. Acute kidney injury (AKI) has been associated with both direct and indirect responses to infection with COVID-19; available evidence suggests that AKI related to COVID-19 is seen in more than 20% of hospitalized patients and more than half of patients admitted to the intensive care unit.
Neha Jain, MD, and colleagues at Highland Hospital, Alameda Health System, Oakland, California, performed a retrospective chart review to examine the incidence of AKI, risk factors, and outcomes in patients with COVID-19 at their center. Results were reported during a poster session at the National Kidney Foundation Spring Clinical Meetings 2023 in a poster titled COVID-19-Related Acute Kidney Injury: Incidence, Risk Factors, and Outcomes in a County Hospital Cohort.
The review included charts for all patients older than 18 years of age who were admitted to the center with a positive COVID-19 test between April 2020 and March 2021. Relevant clinical data were collected from electronic health records and then statistically analyzed. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL from baseline during the hospitalization. The primary outcome measures were in-hospital mortality, transfer to a tertiary center, or patient discharge.
A total of 445 patients were included in the chart review. Of those, 62.7% were men, 35.7% (n=159) had diabetes mellitus, 43.6% (n=194) had hypertension, and 50.3% (n=220) had obesity. Chronic kidney disease (CKD), defined as glomerular filtration rate <60 mL/min/1.73 m2, was present in 19.6% (n=86) and 5.2% (n=23) had end-stage kidney disease.
AKI developed in 38.5% (n=171) of patients. Of those, 7.2% (n=32) required renal replacement therapy. One patient underwent kidney biopsy that showed collapsing focal segmental glomerulosclerosis. Oxygen support was required in 74.4% (n=331) and 13% (n=58) required ventilatory support. Patients who recovered were discharged (86.1%; n=383) or transferred to a tertiary center (2.2%; n=10). Fifty-two patients died (11.7%).
Risk factors significantly associated with development of AKI were male sex, diabetes mellitus, hypertension, and CKD at baseline (P<.05). There was no significant correlation between AKI and outcomes (P<.05).
“Hospitalized patients with COVID-19 infection are at elevated risk of developing AKI. Male sex, diabetes mellitus, hypertension, and CKD are factors associated with a higher risk of developing AKI. In contrast to many other studies, our study did not find a significant correlation between AKI and mortality,” the researchers said.
Source: Jain N, Manjunath V, Luo J. COVID-19 related acute kidney injury: incidence, risk factors and outcomes in a county hospital cohort. Poster #11. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas.