ABSTRACT
BACKGROUND: Hospitalized patients with SARS-CoV2 develop acute kidney injury (AKI) frequently, yet gaps remain in understanding why adults seem to have higher rates compared to children. Our objectives were to evaluate the epidemiology of SARS-CoV2-related AKI across the age spectrum and determine if known risk factors such as illness severity contribute to its pattern. METHODS: Secondary analysis of ongoing prospective international cohort registry. AKI was defined by KDIGO-creatinine only criteria. Log-linear, logistic and generalized estimating equations assessed odds ratios (OR), risk differences (RD), and 95% confidence intervals (CIs) for AKI and mortality adjusting for sex, pre-existing comorbidities, race/ethnicity, illness severity, and clustering within centers. Sensitivity analyses assessed different baseline creatinine estimators. RESULTS: Overall, among 6874 hospitalized patients, 39.6% (n = 2719) developed AKI. There was a bimodal distribution of AKI by age with peaks in older age (≥60 years) and middle childhood (5-15 years), which persisted despite controlling for illness severity, pre-existing comorbidities, or different baseline creatinine estimators. For example, the adjusted OR of developing AKI among hospitalized patients with SARS-CoV2 was 2.74 (95% CI 1.66-4.56) for 10-15-year-olds compared to 30-35-year-olds and similarly was 2.31 (95% CI 1.71-3.12) for 70-75-year-olds, while adjusted OR dropped to 1.39 (95% CI 0.97-2.00) for 40-45-year-olds compared to 30-35-year-olds. CONCLUSIONS: SARS-CoV2-related AKI is common with a bimodal age distribution that is not fully explained by known risk factors or confounders. As the pandemic turns to disproportionately impacting younger individuals, this deserves further investigation as the presence of AKI and SARS-CoV2 infection increases hospital mortality risk.
Subject(s)
Acute Kidney Injury/epidemiology , COVID-19/complications , Inpatients/statistics & numerical data , SARS-CoV-2 , Acute Kidney Injury/etiology , Adolescent , Adult , Age Distribution , Age Factors , Aged , Aged, 80 and over , COVID-19/epidemiology , Child , Child, Preschool , Comorbidity , Confidence Intervals , Creatinine/blood , Global Health/statistics & numerical data , Hospital Mortality , Humans , Middle Aged , Odds Ratio , Registries/statistics & numerical data , Severity of Illness IndexABSTRACT
Background: COVID-19 has severely affected some countries with a high mortality rate than others. In Pakistan, its mortality rate is lower (2.06%) than neighboring countries and even economically advanced countries. Here we discuss the distinct characteristic of the Pakistani population that might have contributed to this lower mortality. Methods: COVID-19 mortality data were collected from December, 2019 to July, 2020 and studied for population age spectrum, health facilities, immunization profiles, physical activity, and obesity from Pakistan and other countries. Results: Lower COVID-19 related mortality rate was observed in Pakistan (2.06%) as compared to France (18.02%), Italy (14.45%), UK (14.01%), Spain (9.56%), the USA (4.71%), and Iran (4.77%). Small proportion (3.5%) of the elderly population (>65 years of age), exposure to different viral antigens, a higher rate of BCG vaccination, better physical activity practices, and lower obesity prevalence in Pakistani population as compared European and North American population may contribute to lower COVID-19 related mortality rate. Conclusions: Multiple factors may have contributed to this lower mortality rate in Pakistan. Our observations may facilitate clinicians to identify individuals who may have low risk to COVID-19 related deaths. Comprehensive studies are warrented to address it further.