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
ABSTRACT
Introduction: A hemodialysis unit had been installed at the COVID-19 treatment center of the Kinshasa University Hospital (CTCO/KUH) for COVID-19 patients with acute kidney injury requiring hemodialysis (AKI-3D) and chronic hemodialysis patients with COVID-19 infection (CKD-5D). The aim of the study was to determine the incidence rate of hemodialysis unit admission, and to compare clinical profile and 45-day mortality between the two groups (G1= AKI 3-D, and G2= CKD-5D). Method(s): We underwent a retrospective cohort study using CTCO/KUH data involving the first 4 waves of the Covid-19 pandemic. The incidence rate was calculated based on the total number of cases of SARS-COV-2 infection diagnosed at the CTCO/KUH laboratory and the duration of each wave of the pandemic. The AKI-CKD diagnosis was defined according to KDIGO criteria. The endpoint was survival (time to death) assessed on day 45 starting from the first hemodialysis session at the CTCO/KUH. Dialysis was funded by government partners. Result(s): 2.254 cases of SARS-COV-2 infection and 835 hospitalizations for COVID-19 were recorded: 401/215 in the 1st wave (V1), 835/196 in V2, 508/245 in V3 and 510/178 to V4. Only 43 patients underwent hemodialysis (16 = 37% G1 and 27 = 63% G2). The incidence rate of COVID-19 hemodialysis unit admission was 8.7/ 1000 patient-months during V1 vs 1.9 in V2;4.5 in V3 and 4.7 in V4 (p=0.001). Mean age (58 +/- 13 years G1 vs 56+/-12 years G2, p=0.632) and clinical profile (men 63% vs 85%, p=0.093;diabetics 48% vs 44%, p=0.609;hypertensives 94% vs 89%, p=0.521;obeses 13% vs 7%, p=0.479) between the two groups (G1 vs G2) did not show any statistically significant difference. At Day 45 of follow-up, survival was 75% in G1 vs 89% in G2 (p=0.220). Conclusion(s): The incidence rate of hemodialysis unit admission related to COVID-19 patients was higher during the first wave of the pandemic. The clinical profile and outcome of COVID-19 patients on dialysis for AKI-3D seem comparable with CKD5-D patients. No conflict of interestCopyright © 2023