Incidence and Risk Factors of Acute Kidney Injury in Patients with Severe Covid-19 Infection in Tertiary Care Hospital in Thailand

ABSTRACT

Introduction: Acute kidney injury (AKI) in COVID-19 infection is common, especially in severe diseases, and is associated with worsening outcomes. Data from many countries demonstrate differences in the incidence and risk factors of AKI. However, there is limited data available for AKI among severe COVID-19 patients in Thailand. This study aims to investigate the incidence and identify AKI risk factors in patients with severe COVID-19 infection at tertiary care hospitals. Method(s) In this retrospective cohort study, we analyzed data of patients admitted to the intensive care unit with PCR-confirmed diagnoses of COVID-19 infection from electronic medical records at Thammasat University Hospital. All patients who were admitted between 1st January 2021 and 30th June 2022 were included. Result(s) Of the 215 severe COVID-19-infected patients included, 134 (62.33%) experienced AKI injury. 81 (60.45%), 19 (14.18%), and 34 (25.37%) patients had AKI KDIGO stage 1, 2, and 3, respectively. From the univariate logistic regression analysis, the risk factors of AKI in COVID-19 patients were female, older age, preexisting hypertension, dyslipidemia, coronary artery disease, chronic kidney disease (CKD), higher APACHE II score, low serum albumin, high serum potassium, low serum bicarbonate, presence of proteinuria from dipstick and used of vasoactive drugs. Multivariate analysis showed that pre-existing CKD [odds ratio (OR) 13.95, 95%CI 2.24-86.88;p = 0.005], presence of proteinuria (OR 7.33, 95%CI 1.5-35.78;p=0.014) and APACHE-II score (OR 1.78, 95%CI 1.02-1.36;p=0.024) were independently associated with developing AKI. Multivariate analysis showed that AKI was associated with 30-day mortality with an OR of 4.34;95%CI 1.63-11.51 (p=0.003). Among AKI-patient survivors, 27 patients (20.15%) fully recovered their renal function, 22 patients (16.42%) were not recovering, and 11 patients (8.21%) required kidney replacement therapy during admission. The most common dialysis indication was volume overload. Conclusion(s) AKI in severe COVID-19 patients was common. Pre-existing CKD, presence of proteinuria, and higher APACHE II score were independently associated with AKI. Only one-fifth of AKI survivors had full renal recovery. Thus, the COVID-19 patients with these risk factors should be closely monitored and treated cautiously in order to prevent AKI development. No conflict of interestCopyright © 2023