Acute kidney injury (AKI) is a common complication among patients hospitalized with COVID-19, and risk factors for its development include Black race, older age, and male sex, according to a recent study.
Development of AKI is significantly associated with an increased risk of dying, especially among Black patients.
In addition, the study found that hospital-level AKI rates vary markedly by geography.
“Our results may help inform efforts to optimize the ongoing management of this global pandemic and planning for long-term care needs of convalescent patients with COVID-19,” a team led by Ziyad Al-Aly, MD, of the Veterans Affairs St. Louis Health Care System in St. Louis, Missouri, concluded in a paper published in the Clinical Journal of the American Society of Nephrology.
In a study of 5216 veterans (94% men) hospitalized with COVID-19 within the Department of Veterans Affairs healthcare system, AKI developed in 1655 (32%), with 80% of them experiencing it within the first day of hospitalization, the investigators reported. In addition, 47% of patients with AKI did not recover to baseline serum creatinine levels by the time they were discharged.
Of the 1655 patients with AKI, 961 (58%), 223 (13%), and 270 (16%) had stage 1, 2, and 3 AKI, respectively, based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and 201 (12%) received kidney replacement therapy (KRT).
Predictors of AKI during COVID-19 hospitalization included older age, Black race, male gender, obesity, diabetes, hypertension, and lower estimated glomerular filtration rate (eGFR).
In adjusted analyses, each 10-year increase in patient age was significantly associated with 9% increased odds of any AKI, according to Dr Al-Aly and colleagues. Compared with White patients, Black patients had significant 1.9-fold increased odds of AKI. Compared with female patients, male patients had 2.1-fold increased odds of AKI. Obesity was significantly associated with nearly 1.4-fold increased odds of AKI compared with underweight or normal weight. Diabetes and hypertension each was significantly associated with approximately 1.3-fold increased odds of AKI. An eGFR below 30 and 30 to 45 mL/min/1.73 m2 was significantly associated with 7.3- and 3.3-fold increased odds of AKI, respectively, compared with an eGFR greater than 90 mL/min/1.73 m2.
AKI was significantly associated with more mechanical ventilation use and longer hospital stay.
Overall, the presence of AKI, compared with its absence, was significantly associated with an approximately 6.7-fold increased risk of death. The risk associated with AKI was attenuated by older age and non-Black race. Among patients with AKI, patients below the median age of the cohort had 12.8-fold increased odds of death, whereas those above the median age had a 4.9-fold increased risk. AKI was significantly associated with 9.5-fold increased odds of death among Black patients compared with 5.5-fold increased odds among non-Black patients.
Hospital-level AKI rates varied widely by geography (10% to 56%), and analyses suggest that the percentage of Black patients in the COVID-19 hospitalized population explained 31% of differences in rates, according to Dr Al-Aly and colleagues. Moreover, AKI rates decreased as the pandemic progressed, from 40% in March 2020 to 27% in July 2020, the investigators reported.
Bowe B, Cai M, Xie Y, Gibson AK, Maddukuri G, Al-Aly Z. Acute kidney injury in a national cohort of hospitalized US veterans with COVID-19. Published online November 16, 2020. Clin J Am Soc Nephrol. doi:10.2215/CJN.09610620