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. 2024 Jun;29(6):325-337.
doi: 10.1111/nep.14297. Epub 2024 Mar 28.

The dynamics and outcomes of AKI progression during the COVID-19 pandemic

Aruni Ratnayake  1   2 , Alexander Sarnowski  1 , Fiona Sinclair  1 , Nicholas M P Annear  1   3 , Debasish Banerjee  1   3 , Irina Chis Ster  4
Affiliations

The dynamics and outcomes of AKI progression during the COVID-19 pandemic

Aruni Ratnayake et al. Nephrology (Carlton). 2024 Jun.

Abstract

Purpose: Acute kidney injury (AKI) associated with COVID-19 is associated with poor prognosis. This study assessed the hitherto uninvestigated impact of COVID-19 on the progression and clinical outcomes of patients with AKI.

Methods: Data from 576 patients with AKI admitted between 13/3/20 and 13/5/20 were studied. Increasingly complex analyses, from logistic regressions to competing-risk and multi-state models, have revealed insights into AKI progression dynamics associated with PCR-confirmed COVID-19 acquisition and death. Meta-analyses of case fatality ratios among patients with AKI were also conducted.

Results: The overall case-fatality ratio was 0.33 [95% CI (0.20-0.36)]; higher in COVID-19 positive (COVID+) patients 0.52 [95% CI (0.46-0.58)] than in their negative (COVID-) counterparts 0.16 [95% CI (0.12-0.20)]. In AKI Stage-3 patients, that was 0.71 [95% CI (0.64-0.79)] among COVID+ patients with 45% dead within 14 days and 0.35 [95% CI (0.25-0.44)] in the COVID- group and 28% died within 14 days. Among patients diagnosed with AKI Stage-1 within 24 h, the probability of progression to AKI Stage-3 on day 7 post admission was 0.22 [95% CI (0.17-0.27)] among COVID+ patients, and 0.06 [95% CI (0.03, 0.09)] among those who tested negative. The probability of discharge by day 7 was 0.71 [95% CI (0.66, 0.75)] in COVID- patients, and 0.27 [95% CI (0.21, 0.32)] in COVID+ patients. By day 14, in AKI Stage-3 COVID+ patients, that was 0.35 [95% CI (0.25, 0.44)] with little change by day 10, that is, 0.38 [95% CI (0.29, 0.47)].

Conclusion: These results are consistent with either a rapid progression in severity, prolonged hospital care, or high case fatality ratio among AKI Stage-3 patients, significantly exacerbated by COVID-19 infection.

Keywords: COVID‐19; acute kidney injury dynamics; competing risks and multi‐state models; death; meta‐analyses.

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References

REFERENCES

    1. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1‐138.
    1. Wang L, Li X, Chen H, et al. Coronavirus disease 19 infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan. China Am J Nephrol. 2020;51(5):343‐348.
    1. Robbins‐Juarez SY, Qian L, King KL, et al. Outcomes for patients with COVID‐19 and acute kidney injury: a systematic review and meta‐analysis. Kidney Int Rep. 2020;25(8):1149‐1160.
    1. Kudose S, Batal I, Santoriello D, et al. Kidney biopsy findings in patients with COVID‐19. J Am Soc Nephrol. 2020;31(9):1959‐1968.
    1. Santoriello D, Khairallah P, Bomback AS, et al. Postmortem kidney pathology findings in patients with COVID‐19. J Am Soc Nephrol. 2020;31(9):2158‐2167.