COVID-19-associated AKI

Abstract

Purpose of review: While it is now widely established acute kidney injury (AKI) is a common and important complication of coronavirus disease (COVID-19) disease, there is marked variability in its reported incidence and outcomes. This narrative review provides a mid-2022 summary of the latest epidemiological evidence on AKI in COVID-19.

Recent findings: Large observational studies and meta-analyses report an AKI incidence of 28-34% in all inpatients and 46-77% in intensive care unit (ICU). The incidence of more severe AKI requiring renal replacement therapy (RRT) in ICU appears to have declined over time, in data from England and Wales RRT use declined from 26% at the start of the pandemic to 14% in 2022. The majority of survivors apparently recover their kidney function by hospital discharge; however, these individuals appear to remain at increased risk of future AKI, estimated glomerular filtration rate (eGFR) decline and chronic kidney disease. Importantly even in the absence of overt AKI a significant proportion of survivors of COVID-19 hospitalisation had reduced eGFR on follow-up.

Summary: This review summarises the epidemiology, risk factors, outcomes and treatment of COVID-19-associated AKI across the global pandemic. In particular the long-term impact of COVID-19 disease on kidney health is uncertain and requires further characterisation.

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FIGURE 1

Schematic representation of the incidence, risk factors, treatment and outcomes of patients with COVID-19 and AKI in the community, hospital, ICU and post-discharge. Image credits: Panel 1 Green Street, Newham author Steve Daniels https://commons.wikimedia.org/wiki/Category: Green_Street,–Newham#/media/File:Green_Street_-_geograph.org.uk_-_2200969.jpgCreative Commons Attribution-Share Alike 2.0 Generic license Panel 2 Royal London Hospital author Matt from London https://en.wikipedia.org/wiki/Royal_London_Hospital#/media/File:Royal_London_Hospital_redevelopment.jpgCreative Commons Attribution 2.0 Generic license Panel 3 Covid-19 ICU patient in São Paulo author Gustavo Basso https://en.wikipedia.org/wiki/COVID-19_pandemic#/media/File:Covid-19_SP_-_UTI_V._Nova_Cachoeirinha.jpgCreative Commons Attribution-Share Alike 4.0 International license Panel 4 Arvin McCray, first COVID-19 patient goes home aft 50 days Milwaukee VA Medical Center https://commons.wikimedia.org/wiki/File:Arvin_McCray,_first_COVID-19_patient_goes_home_aft_50_days_%2849860636542%29.jpgAs a work of the U.S. federal government, the image is in the public domain.