Mustafa ARICI, Nurhan SEYAHİ, Erkan ŞENGÜL, Kenan TURGUTALP, Mürşide Esra DÖLARSLAN, Savaş ÖZTÜRK, Feyza BORA, Tuba Elif ÖZLER, Yavuz AYAR, Ali Rıza ODABAŞ, Kenan ATEŞ, Ekrem KARA, Mehmet Rıza ALTIPARMAK, Savaş SİPAHİ, Serkan BAKIRDÖĞEN, Özkan GÜNGÖR, Hakkı ÇETİNKAYA, Zeki AYDIN, Zeki SOYPAÇACI, İdr

Impact of hospital-acquired acute kidney injury on Covid-19 outcomes in patients with and without chronic kidney disease: a multicenter retrospective cohort study

Background/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods: HA-AKI development was assessed in a group of stage 3–5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results: Among 621 hospitalized patients (age 60 [IQR: 47–73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9–44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9–33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion: AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.Key words: Acute kidney injury, chronic kidney disease, Covid-19, hospitalization, mortality

PDF

___

1. Ng JJ, Luo Y, Phua K, Choong AM. Acute kidney injury in hospitalized patients with coronavirus disease 2019 (COVID-19): A meta-analysis. Journal of Infection 2020; 81 (4): 647-679. doi: 10.1016 / j.jinf.2020.05.009
2. Cheng Y, Luo R, Wang K, Zhang M, Wang Z et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International 2020; 97 (5): 829-838. doi: 10.1016 / j.kint.2020.03.005
3. Zhou F, Yu T, Du R, Fan G, Liu Y et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062. doi: 10.1016 / S0140-6736 (20) 30566-3
4. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney International 2020; 98 (1): 209-218. doi: 10.1016 / j.kint.2020.05.006
5. Selby NM, Forni LG, Laing CM, Horne KL, Evans RD et al. Covid-19 and acute kidney injury in hospital: summary of NICE guidelines. British Medical Journal 2000; 26: 369: m1963. doi: 10.1136 / bmj.m1963
6. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF et al. A new equation to estimate glomerular filtration rate. Annals of Internal Medicine 2009; 150 (9): 604-612. doi: 10.7326 / 0003-4819-150-9-200905050-00006
7. Guidance to COVID-19 (SARS Cov2 Infection) (Scientific Board Study) Republic of Turkey Ministry of Health (published on April 14). Accessed 18 April.
8. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Section 2: AKI Definition. Kidney International Supplements (2011) 2012; 2(1): 19-36. doi: 10.1038 / kisup.2011.32
9. Chapter 1: Definition and classification of CKD. Kidney International Supplements 2013; 3(1): 19-62. doi: 10.1038/ kisup.2012.64
10. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney International 2020; 98(1): 209-218. doi: 10.1016 / j.kint.2020.05.006
11. Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. British Medical Journal 2020; 369: p. m1996. doi: 10.1136 / bmj.m1996
12. Chan L, Chaudhary K, Field A, Chauhan K, Vaid A et al. Acute Kidney Injury in Hospitalized Patients with COVID-19. medRxiv: the preprint server for health sciences 2020; p. 2020.05.04.20090944. doi: 10.1101 / 2020.05.04.20090944
13. Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. International Urology and Nephrology 2020; 52(6): 1193-1194. doi: 10.1007 / s11255-020-02451-9
14. Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F et al. World incidence of AKI: a meta-analysis. Clinical Journal of the American Society of Nephrology 2013. 8(9): 1482-1493. doi: 10.2215 / CJN.00710113
15. Srisawat N, Sileanu F, Murugan R, Bellomod R, Calzavacca P et al. Variation in risk and mortality of acute kidney injury in critically ill patients: a multicenter study. American Journal of Nephrology 2015. 41(1): 81-88. doi: 10.1159 / 000371748
16. Srisawat N, Sileanu F, Murugan R, Bellomod R, Calzavacca P et al. Incidence, Outcomes, and Comparisons across Definitions of AKI in Hospitalized Individuals. Clinical Journal of the American Society of Nephrology 2014; 9(1): 12-20. doi: 10.2215 / CJN.02730313
17. Hsu CY, Ordoñez JD, Chertow GM, Fan D, McCulloch CE et al. The risk of acute renal failure in patients with chronic kidney disease. Kidney International 2008; 74(1): 101-107. doi: 10.1038 / ki.2008.107