Abstract
Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients.
Highlights
The incidence of Acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis
These findings enhance the impact of advanced age, Chronic Kidney Disease (CKD) and hypertension as major risk factors for acute kidney damage, with higher incidence seen in patients who developed a more severe and persistent disease
We demonstrated that Acute Kidney Disease (AKD) patients were a subpopulation of AKI patients with increased risk of in-hospital mortality
Summary
The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Acute kidney injury (AKI) has been reported as a severe complication of COVID-19 with a higher risk of mortality [2]. The reported incidence of AKI among hospitalized patients with COVID-19 varies widely, with rates as high as 36–46% [3,4,5]. Dehydration, rhabdomyolysis, hypoxemia, the presence of underlying disease and improper administration of nephrotoxic substances can further contribute to renal failure in COVID-19 patients [12,13]
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