Acute Kidney Injury and Augmented Renal Clearance Risk Factor Assessment in Patients with Covid-19

ABSTRACT

INTRODUCTION: While COVID19 was initially thought to only affect the lungs, the virus also affects other organs including the kidneys. This has led to reports of renal function alterations including impairment and enhancement. The incidence of acute kidney injury (AKI) and augmented renal clearance (ARC) has been reported to be 25-35% and 25-75%, respectively. Several risk factors for AKI and ARC have been reported with many overlapping. This study sought to identify which patients might experience AKI vs ARC. METHOD(S) Hospitalized, adult patients with laboratory confirmed COVID19 from the National COVID Cohort Collaborative (N3C) database were included in this retrospective study. Patients who had all data to calculate creatinine clearance (CrCl) via Cockroft-Gault were screened and excluded for pregnancy, body mass index < 18kg/m2, history of end-stage renal disease on dialysis or nephrectomy, or lacking data to determine exclusion criteria. AKI and ARC were defined using AKIN criteria and CrCl >130mL/min, respectively. Potential demographic and biomarker predictors of AKI or ARC were considered in univariate and multivariate logistic regression models. RESULT(S) 11,274 patients were included in univariate and multivariate logistic regression analysis. 20.1% developed AKI and 34.2% experienced ARC. Significant variables associated with AKI included age, weight, height, white race, male sex, Hispanic ethnicity, and diabetes (OR 0.996, 1.01, 0.73, 0.969, 1.1, 1.11, and 1.06, respectively). Age, weight, black race, male sex, Hispanic ethnicity, and hypertension were all associated with experiencing ARC (OR 0.973 1.01, 0.753, 0.945, 1.15, 0.911, respectively). No biomarker variables were available from N3C database. CONCLUSION(S) While a significant proportion of patients with COVID19 experience alterations in renal function, there are many overlapping risk factors for the development of AKI or ARC including age, weight, and Hispanic ethnicity, with male sex as the only differentiating patients at risk for AKI vs ARC. Thus, determining which patient may be at risk for renal dysfunction or enhancement based on their demographic is still unknown. Further investigation is needed to identify patients who are at risk for each of these renal function alterations.