Abstract
Acute kidney injury (AKI) is associated with poor outcomes in COVID patients. Differences between hospital-acquired (HA-AKI) and community-acquired AKI (CA-AKI) are not well established. Prospective, observational cohort study. We included 877 patients hospitalized with COVID diagnosis at two third-level hospitals in Mexico. Primary outcome was all-cause mortality at 28 days compared between COVID patients with CA-AKI and HA-AKI. Secondary outcomes included the need for KRT, and risk factors associated with the development of CA-AKI and HA-AKI. A total of 377 patients (33.7%) developed AKI. CA-AKI occurred in 202 patients (59.9%) and HA-AKI occurred in 135 (40.1%). Patients with CA-AKI had more significant comorbidities, including diabetes (52.4% vs 38.5%), hypertension (58.4% vs 39.2%), CKD (30.1% vs 14.8%), and COPD (5.9% vs 1.4%), than those with HA-AKI. Patients' survival without AKI was 87.1%, with CA-AKI it was 75.4%, and with HA-AKI it was 69.6%, log-rank test p < 0.001. Only age > 60 years (OR 1.12, 95% CI 1.06-1.18, p <0.001), COVID severity (OR 1.09, 95% CI 1.03-1.16, p = 0.002), the need in mechanical lung ventilation (OR 1.67, 95% CI 1.56-1.78, p <0.001), and HA-AKI stage 3 (OR 1.16, 95% CI 1.05-1.29, p = 0.003) had a significant increase in mortality. The presence of CKD (OR 1.48, 95% CI 1.391.56, p < 0.001), serum lymphocytes < 1000 μL (OR 1.03, 95% CI 1.00-1.07, p = 0.03), the need in mechanical lung ventilation (OR 1.06, 95% CI 1.02-1.11, p = 0.003), and CA-AKI stage 3 (OR 1.37, 95% CI 1.29-1.46, p < 0.001) were the only variables associated with a KRT start. We found that COVID patients who are complicated by CA-AKI have more comorbidities and worse biochemical parameters at the time of hospitalization than HA-AKI patients, but despite these differences, their probability of dying is similar.
Highlights
COVID-19 has been a unique challenge to the field of nephrology
We found that COVID patients who are complicated by CA-Acute kidney injury (AKI) have more comorbidities and worse biochemical parameters at the time of hospitalization than HA-AKI patients, but despite these differences, their probability of dying is similar
We identified community-acquired AKI when the patient met any of the following criteria: (a) an increased serum creatinine (Scr) level at admission and a trend of decreasing Scr levels during the hospital stay; (b) an increased Scr level at admission and an Scr level that continued to increase or remained at a high level during the hospital stay, with preadmission Scr values establishing the existence of AKI; or (c) normal kidney function upon admission with Scr levels that began to increase and AKI that could be defined within 2 days after hospitalization combined with causal factors that were determined to be present prior to admission based on review of their medical records
Summary
Acute kidney injury (AKI) presents in 4.5% of cases [1] and up to 78% of patients in the intensive care unit [2]. AKI is associated with poor outcomes [3], and it has been reported that AKI has the highest risk of mortality in hospitalized patients [4]. It has been reported that the development of in-hospital (HA) AKI confers a greater risk of mortality than in patients with communityacquired (CA) AKI [8,9,10], but little is known regarding the outcomes of AKI according to the site of acquisition in COVID patients. Acute kidney injury (AKI) is associated with poor outcomes in COVID patients. Differences between hospital-acquired (HA-AKI) and community-acquired AKI (CA-AKI) are not well established
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