POS-025 PREVALENCE, CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH COVID-19 ASSOCIATED ACUTE KIDNEY INJURY – A TERTIARY CENTRE EXPERIENCE FROM SOUTH INDIA

Abstract

The recent COVID-19 pandemic has caused a deleterious effect on health and all organ systems. The quintessential manifestation of renal involvement is acute kidney injury (AKI). In our study, we aim to estimate the prevalence, clinical profile and outcomes in patients with Covid-19 associated AKI. This was a retrospective observational study amongst hospitalized COVID-19 patients admitted at our tertiary care centre between April 1 and December 31, 2021. We estimated the prevalence of AKI, requirement of renal replacement therapy (RRT), outcomes including mortality and acute kidney disease (AKD) at the time of discharge. The data of all patients including AKI, Acute worsening of preexisting chronic kidney disease (CKD) and renal transplants were also included. ESRD on maintenance hemodialysis were excluded from the study. Regression analysis was done to study the factors associated with mortality and AKD. Out of 12,450 hospitalized patients with COVID-19, 578 (4.6%) patients had AKI. Mean age of patients with AKI was 58 years, out of which 60.7% were males. Comorbidities include diabetes mellitus in 59.5%, hypertension in 64.9%, heart disease in 35.3%, old cerebrovascular accident (CVA) in 23.5%, Chronic obstructive pulmonary disease (COPD) in 19.4%, Chronic Liver Disease (CLD) in 11.2% and Chronic Kidney Disease (CKD) in 32.9%. Patients having KDIGO Stage 1, 2 and 3 AKI were 15.5%, 20.5% and 63.8% respectively. RRT was warranted in 40.7% of patients, out of which 24.6% underwent hemodialysis (HD) and 16.1% acute intermittent peritoneal dialysis(PD). Severity of Covid-19 was classified as mild, moderate, severe, and very severe in 35.6%; 32.8% ,15.7% and 15.7% respectively depending on CT severity. Overall mortality in patients with AKI was 28.5%. Mortality in those requiring HD was 61.2% and in those requiring acute intermittent PD was 32.1%. AKI resolved in 35.6% and among survivors without preexisting CKD, 28.7% patients had acute kidney disease at the time of discharge. The need for inotrope support, mechanical ventilation, hemodialysis, acute intermittent PD and preexisting CKD were the multivariate predictors of mortality. Diabetes mellitus, need for hemodialysis and ionotropic support were multivariate predictors of AKD. The prevalence of AKI in our study population was low (4.6%). Mortality in Covid-19 associated AKI was 28.7% and it was particularly high in patients with pre-existing CKD, hypoxemia, hypotension, higher CT severity, secondary sepsis, stage 3 AKI, need for RRT and need for mechanical ventilation. It is found that higher the severity of AKI, worse the prognosis. Among survivors, a significant percentage had AKD at the time of discharge.