AKI linked to poor outcomes after COVID-19, including continued need for dialysis
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A study conducted by the Feinstein Institutes for Medical Research adds to the growing body of evidence that links AKI to increased mortality risk for patients hospitalized with COVID-19.
While Healio Nephrology has reported on a variety of such studies, this research also determined 30.6% of patients who required kidney replacement therapy (KRT) after developing AKI remained on dialysis at discharge.
“It is important to note that most patients who develop acute kidney injury with COVID-19 have recovery of their kidney function before they leave the hospital,” co-author Steven Fishbane, MD, chief of the division of kidney disease and hypertension at Northwell Health, told Healio Nephrology. “It is concerning, though, that a small number require dialysis even after hospital discharge.”
For the study, Fishbane and colleagues compared outcomes between 9,657 patients with COVID-19 who were admitted to one of 13 New York City hospitals. Researchers noted that the study population was racially and ethnically diverse, with a mix of patients from community and tertiary hospitals. Considered outcomes included in-hospital mortality, need for dialysis at discharge or recovery of kidney function.
When examining the entire sample size, investigators found results the AKI incidence rate was 38.4 per 1,000 patient-days.
Regarding mortality, researchers observed the incidence rates of in-hospital death to be 10.8 per 1,000 patient-days for patients without AKI, 31.1 for those with AKI not on KRT and 37.5 for those with AKI who also required KRT.
In addition, the risks of in-hospital mortality for patients with AKI-non KRT and AKI-KRT were greater than among those without AKI (HR = 5.6 and HR = 11.3, respectively).
After adjusting for demographics, comorbidities and illness severity, researchers determined the mortality risk continued to be higher among those with AKI than those without AKI (AKI non-KRT, HR = 3.4; AKI with KRT, HR =6.4).
Further findings indicated 74.1% of patients with AKI who were not on KRT recovered kidney function by the time of discharge. However, for patients with AKI who were receiving KRT, 30.6% remained on dialysis at discharge.
According to Fishbane, these results suggest the nephrology community needs to better understand how patients with COVID-19 recover from AKI.
“At present, we do not have sufficient outpatient follow-up data to inform an understanding of the impact of AKI in COVID-19 on the subsequent development of CKD,” the researchers wrote. “Long-term follow-up of such patients is crucial, as prior AKI literature has demonstrated increased kidney injury progression persisting for up to [10] years following hospital admission with AKI, despite an apparent normalization of kidney function post-discharge.”
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