Risk factors for AKI and mortality in COVID-19 in Western Mexico

Background: Acute kidney injury (AKI) in COVID-19 is associated with disease severity. The aim of this study was to identify risk factors associated with the development of AKI and its clinical impact, such as need for RRT and mortality. Methods: Retrospective cohort study of hospitalized adult patients COVID-19, with normal kidney function, from April to December 2020 in Western Mexico. Results: 882 patients (60.8% men) with a mean age of 58.9y were included. 342 (38.8%) had a prior diagnosis DM, 412 (46.7%) HTN, 161 (18.3%) obesity, 59 (6.7%) heart diseases, 25 (2.8%) neurological disease, 47 (5.3%) lung disease. 216 (24.5%) smoking history. 270 patients (30.6%) developed AKI, 95 (10.77%) KDIGO stage 1, 44 (4.98%) stage 2, and 84 (9.52%) stage 3. 59 patients required RRT (6.23%), and 111 patients (12.6%) mechanical ventilation. Overall mortality was 30.6% (270 patients). Risk factors for mortality were: DM, HTN, neurological disease, age > 65 y, need for MV, and MAP < 65 mmHg, hyperNa, increased D-dimer or decreased HCO3 at admission. Risk factors for AKI were: DM, HTN, heart disease, age > 65 y, need for MV, and MAP < 65 mmHg, hyperNa, increased D-dimer or decreased HCO3 at admission. Image shows risk factors, ORs with CI. Conclusions: A high incidence of AKI in the Mexican population compared to reports from other countries, with a significantly high risk for death.

Mortality in COVID-19 patients with CKD with and without kidney replacement therapy in Western Mexico

Background: COVID-19 is a new disease of pandemic proportions. Currently, there are no reports on clinical outcomes in patients with CKD with and without KRT in the Mexican population. Our aim was to describe the clinical outcomes in patients with CKD. Methods: Retrospective cohort study of hospitalized adult patients COVID-19 confirmed with RT-PCR, from April to December 2020 in a second-level hospital in Western Mexico. Information was obtained from medical records. Results: 1012 patients were included, of which 130 patients (12.8%) had CKD (65.3% men), with a mean age of 53.8 years, 43.8% with Diabetes Mellitus and 82.3% with Hypertension. 84 patients (64.6%) were on KRT, within which 47 patients were on hemodialysis, 31 on peritoneal dialysis and 6 with a kidney transplant. 46 patients had no KRT, in stages ranging from KDIGO 3b to 5. 78.4%. 14 patients (10.7%) required mechanical ventilation. In our study, mortality among patients with normal kidney function was 30.6%. Regarding patients with CKD, patients on hemodialysis had a mortality of 25.5% (OR 0.74, 95% CI 0.39-1.5), patients on peritoneal dialysis had a mortality of 54.8% (OR 2.75, 95% CI 1.33-5.66), patients with CKD and no KRT had a mortality of 43.5% (OR 1.74, 95% CI 1.15-3.17). Conclusions: In our population, an increased mortality was found in patients with CKD with and without KRT, highlighting the mortality of patients on PD.

Comparison of rates of AKI between two COVID-19 surges in hospitalized patients in the bronx

Background: The incidence of AKI in COVID 19 is very variable across the world. In New York City it was as high as 36% in a large series in early 2020. However, the incidence of AKI during the second surge between Oct of 2020 to early 2021 is unknown. In this study, we compared these two COVID-19 periods for the incidence of AKI amongst hospitalized patients. Methods: This was a multi-center, retrospective cohort study of patients hospitalized with COVID-19 between March 1st and July 16th 2020 (n=1,719), and between October 15th 2020 and February 28th 2021(n=997) in two NYC public hospitals, (total n= 2,716). Patients < 18 years, with End Stage Kidney Disease or a kidney transplant were excluded. Chi-squared test and Fisher's exact test were used to compare the clinical characteristics of the patients. A p-value less than 0.05 was considered statistically significant. Results: The baseline clinical characteristics and demographics of the two surges were similar. The incidence of AKI as defined by KDIGO criteria, during admission decreased from 28.7% in the first surge to 18.6% in the second surge (p<0.0001). This trend was seen both at encounter level too as shown below. For laboratory characteristics, more patients with hypernatremia and with peak CRP > 50 (Ref range: <50) presented in the first surge than the second surge (p<0.0001). No differences in the peak potassium and peak D-Dimer, or ICU admission rates were seen between two surges. However, significantly more AKI patients in the first surge were on mechanical ventilation as compared to the second surge (p=0.0196). Conclusions: To our knowledge this is the first comparison reported between rates of AKI in hospitalized patients with COVID-19 during two different surge periods. The difference may be related to less severe disease during the second surge, though ICU admission rate was the same. Better care established by the time of the second surge and improved therapeutics such as early use of anti-viral agents, corticosteroids, and anticoagulation may have contributed to better outcomes. Improvement in care of COVID-19 in the second surge may have contributed to a decline in the incidence of AKI. Future studies are needed to see if this trend towards lower AKI incidence continues.