Acute kidney injury with COVID-19 shows potential for ‘lifetime’ impact
A study of U.S. veterans hospitalized with COVID-19 showed 32% developed AKI, with many not fully recovering kidney function by discharge. Black individuals were at greatest risk for AKI and resulting mortality.
“Reports of COVID-19–associated AKI in the United States have so far been limited to a few studies from regional health systems,” Benjamin Bowe, MPH, of the Veterans Affairs St. Louis Health Care System, and colleagues wrote. “The emerging evidence suggests variable rates of AKI and substantial geographic heterogeneity. More evidence on characteristics and outcomes of AKI from various health systems representing different populations is needed to arm clinicians, hospital administrators, public health officials and policy makers with a deeper and more comprehensive understanding of COVID-19–associated AKI to optimize management of this disease and its complications.”
To this end, Bowe and colleagues assessed a cohort of 5,216 U.S. veterans hospitalized with COVID-19 and identified through July 23, 2020. Investigators considered changes in serum creatinine and examined predictors of AKI and the associations between AKI, health resource utilization and mortality.
Of the study population, 32% developed AKI with 58%, 13% and 16% having stage 1, stage 2 and stage 3 disease, respectively; 12% required kidney replacement therapy.
Researchers determined 8% of participants had AKI within 1 day of hospitalization and 47% did not recover to baseline serum creatinine by discharge.
AKI was associated with higher mechanical ventilation use (odds ratio = 6.46; 95% confidence interval, 5.52 to 7.57) and longer hospital stays (5.56 additional days).
Further findings suggested older age, Black race, male gender, obesity, diabetes, hypertension and lower eGFR were significant predictors of AKI during hospitalization.
Regarding mortality, individuals who developed AKI had a 6.7-times higher risk of death; this association was stronger in Black patients.
Bowe and colleagues noted most patients with AKI were in Arizona, California, Florida, Illinois, Indiana, Michigan, New Jersey, New York and Texas.
“Substantial geographic variability in hospital-level rates of AKI was observed, with rates ranging from 10% to 56%,” they wrote. “Analyses of the national variability in AKI rates between hospital systems suggested that the COVID-19 hospitalized population percentage of Black race explained 31% of differences in rates, followed by mean age, mean [area deprivation index] ADI, rates of obesity, rates of diabetes, rates of hypertension and CKD.”
Ziyad Al-Aly, MD, lead investigator on the study, commented on the findings in a related press release.
“This is the first national study of AKI in COVID-19, and it told us that AKI is very common,” he said. “It was also striking to see that nearly half of the veterans with AKI left the hospital with unresolved AKI — meaning that they will likely need long-term follow-up and care, they will also likely suffer long-term consequences lasting their lifetime. Their kidneys are scarred by COVID-19. Unresolved AKI and its long-term consequences are going to be part of the ‘long-haul COVID-19.’”