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. 2023 May 27;8(8):1514-1530.
doi: 10.1016/j.ekir.2023.05.015. Online ahead of print.

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Marina Wainstein  1   2   3 , Nicholas Spyrison  4 , Danyang Dai  5 , Moji Ghadimi  4 , Jonathan S Chávez-Iñiguez  6 , Lilia Rizo-Topete  7 , Barbara Wanjiru Citarella  3 , Laura Merson  3 , Jason D Pole  5 , Rolando Claure-Del Granado  8   9 , David W Johnson  10   11   12 , Sally Shrapnel  3   5   13 ; ISARIC Characterization Group
Collaborators, Affiliations

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Marina Wainstein et al. Kidney Int Rep. .

Abstract

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population.

Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay.

Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity.

Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes.

Keywords: COVID-19; acute kidney injury; community-acquired AKI; country income; dialysis; in-hospital death.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Analysis cohort contributing countries. HIC, high income country; LLMIC, low- and low-middle income country; UMIC, upper-middle income country. ∗ Countries that contributed only 1 patient are not presented in this figure.
Figure 3
Figure 3
Temporal distribution of admissions by country income group. HIC, high income country; LLMIC, low- and low-middle income country; UMIC, upper-middle income country.
Figure 4
Figure 4
AKI incidence and breakdown by country income group. AKI, acute kidney injury; HIC, high income country; LLMIC, low- and low-middle income country; UMIC, upper-middle income country.
Figure 5
Figure 5
Community-acquired versus hospital-acquired acute kidney injury based on 48 hour cutoff from admission by country income group. AKI, acute kidney injury; HIC, high income country; LLMIC, low- and low-middle income country; UMIC, upper-middle income country.
Figure 6
Figure 6
Kaplan–Meier Survival plot stratified across acute kidney injury and country income groups. Confidence bars are used to illustrate a 95% confidence interval. AKI, acute kidney injury; HIC, high income country; LLMIC, low- and low-middle income country; SES, socioeconomic status; UMIC, upper-middle income country.
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