Long-term outcomes of COVID-19 survivors with hospital AKI: association with time to recovery from AKI.

Abstract

Although coronavirus disease 2019 (COVID-19) patients who develop in-hospital acute kidney injury (AKI) have worse short-term outcomes, their long-term outcomes have not been fully characterized. We investigated 90-day and 1-year outcomes after hospital AKI grouped by time to recovery from AKI. This study consisted of 3296 COVID-19 patients with hospital AKI stratified by early recovery (<48hours), delayed recovery (2-7days) and prolonged recovery (>7-90days). Demographics, comorbidities and laboratory values were obtained at admission and up to the 1-year follow-up. The incidence of major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE), rehospitalization, recurrent AKI and new-onset chronic kidney disease (CKD) were obtained 90-days after COVID-19 discharge. The incidence of hospital AKI was 28.6%. Of the COVID-19 patients with AKI, 58.0% experienced early recovery, 14.8% delayed recovery and 27.1% prolonged recovery. Patients with a longer AKI recovery time had a higher prevalence of CKD (P<.05) and were more likely to need invasive mechanical ventilation (P<.001) and to die (P<.001). Many COVID-19 patients developed MAKE, recurrent AKI and new-onset CKD within 90days, and these incidences were higher in the prolonged recovery group (P<.05). The incidence of MACE peaked 20-40days postdischarge, whereas MAKE peaked 80-90days postdischarge. Logistic regression models predicted 90-day MACE and MAKE with 82.4±1.6% and 79.6±2.3% accuracy, respectively. COVID-19 survivors who developed hospital AKI are at high risk for adverse cardiovascular and kidney outcomes, especially those with longer AKI recovery times and those with a history of CKD. These patients may require long-term follow-up for cardiac and kidney complications.