ABSTRACT
Introduction: Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). kidney damage linked to COVID-19 could take on specific characteristics by genetic, environmental and socio-cultural factors. This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in COVID-19 patients at Centre Medical de Kinshasa (CMK). Method(s): In a prospective cohort study carried out at the Kinshasa Medical Center (KMC), consecutive patients admitted to the ICU were screened for the presence of AKI from March 1st, 2020 to January 1st, 2022 period covered the first 4 waves of the Covid-19 pandemic. We included all adult inpatients (>=18 years old) with a positive COVID-19 PCR result. Patients on chronic dialysis (hemodialysis or peritoneal dialysis) and those with less than two creatinine measurements were excluded. Aki was defined according KDIGO guidelines. Univariate and multivariate analysis were performed by Cox regression to identify risk factors for AKI and association between AKI and in-hospital mortality. The significance level of p value was set at 0.05. Result(s): A total of 217 patients were included in the study of which most were males (77.0%) and blacks (80.2%). AKI was diagnosed in 63 out of 217 (29%) COVID-19 patients after a median time of 2 days (0-7). Stages 1, 2, or 3 AKI accounted for 39.7%, 11.1% and 49.2%, respectively. Hemodialysis was performed in 7.8% of the subjects and 69.8% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were first COVID-19 wave (HR: 3.1 [1.2-8.4] p=0.022), obesity (HR: 1.2 [1.02-6.7] p=0.046), higher SOFA score (HR: 6.1 [2.1-17.3] p=0.001) and CRP at day 7 (HR: 1.9 [1.1-10.0] p=0.023). Patients with AKI had a mortality rate of 57.1%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93-4.65] p=0.013) compared to non-AKI patients. Conclusion(s): AKI was present in three out of ten COVID-19 patients. The most significant risk factors for AKI were first wave, obesity, higher SOFA score and CRP. Despite dialysis, AKI has been associated with almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI. No conflict of interestCopyright © 2023