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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study.
Pitre, Tyler; Dong, Angela Hong Tian; Jones, Aaron; Kapralik, Jessica; Cui, Sonya; Mah, Jasmine; Helmeczi, Wryan; Su, Johnny; Patel, Vivek; Zia, Zaka; Mallender, Michael; Tang, Xinxin; Webb, Cooper; Patro, Nivedh; Junek, Mats; Duong, MyLinh; Ho, Terence; Beauchamp, Marla K; Costa, Andrew P; Kruisselbrink, Rebecca; Tsang, Jennifer L Y; Walsh, Michael.
  • Pitre T; Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
  • Dong AHT; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Jones A; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Kapralik J; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Cui S; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Mah J; Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
  • Helmeczi W; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Su J; Department of Medicine, Dalhousie University, Halifax, NS, Canada.
  • Patel V; Department of Internal Medicine, University of Ottawa, ON, Canada.
  • Zia Z; Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
  • Mallender M; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Tang X; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Webb C; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Patro N; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Junek M; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Duong M; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Ho T; Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
  • Beauchamp MK; Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
  • Costa AP; Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
  • Kruisselbrink R; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
  • Tsang JLY; Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
  • Walsh M; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Can J Kidney Health Dis ; 8: 20543581211027759, 2021.
Article in English | MEDLINE | ID: covidwho-1320523
ABSTRACT

BACKGROUND:

The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population.

OBJECTIVE:

To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI.

DESIGN:

Retrospective cohort study from a registry of patients with COVID-19.

SETTING:

Three community and 3 academic hospitals. PATIENTS A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. MEASUREMENTS Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality.

METHODS:

We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality.

RESULTS:

Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]).

LIMITATIONS:

Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences.

CONCLUSIONS:

Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. TRIAL REGISTRATION The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Can J Kidney Health Dis Year: 2021 Document Type: Article Affiliation country: 20543581211027759

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Can J Kidney Health Dis Year: 2021 Document Type: Article Affiliation country: 20543581211027759