Study sheds light on AKI in patients with and without COVID-19
Click Here to Manage Email Alerts
After assessing AKI in patients with and without COVID-19, researchers from Montefiore Medical Center in New York identified distinct patient characteristics and outcomes associated with the infection.
Among other findings, the researchers determined a higher incidence of AKI in patients who also had COVID-19, with these patients being less likely to recover kidney function than those with AKI only.
“Reports from centers treating patients with coronavirus disease 2019 (COVID-19) have noted that such patients frequently develop AKI,” Molly Fisher, DO, of the Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, New York, and colleagues wrote. “However, there have been no direct comparisons of AKI in hospitalized patients with and without COVID-19 that would reveal whether there are aspects of AKI risk, course, and outcomes unique to this infection.”
Furthermore, the researchers contended that their study population — which consisted not only of patients hospitalized with AKI in the COVID-19 era, but also of a historical control cohort of those hospitalized a year earlier — was representative of a group at increased risk for adverse outcomes from COVID-19 due to greater disease burden and comorbidities.
“The Bronx is the one of the nation’s poorest urban counties and has excess mortality rates from heart disease, stroke, and diabetes compared with national averages,” they wrote. “A recent study of the five boroughs of New York City demonstrated that the Bronx had the highest rate of hospitalizations and deaths due to COVID-19 per 100,000 population.”
With this in mind, Fisher and colleagues evaluated AKI incidence, risk factors and outcomes in 3,345 adults with COVID-19 and 1,265 without COVID-19 (9,859 people made up the historical cohort).
Results showed a higher AKI incidence among patients with COVID-19 compared with those without COVID-19 who were hospitalized during the pandemic (56.9% vs. 37.2%), as well as when compared with the historical cohort in which AKI occurred in 25.1% of hospitalized patients. Patients with AKI and COVID-19 were more likely to require renal replacement therapy (RRT; 4.9%) than those without COVID-19 and the historical cohort (1.6% and 0.9%, respectively). They were also less likely to recover kidney function.
Regarding mortality, researchers determined in-hospital death to be 33.7% for patients with COVID-19 and AKI compared with 9.3% for patients with COVID-19 but no AKI. For patients without COVID-19, in-hospital death was 13.4% for those with AKI vs. 3.7% for those without AKI.
Further findings indicated that in the total cohort of patients (with and without AKI), in-hospital death was significantly higher in patients who tested positive for COVID-19 (23.2% vs. 7.3% for those who tested negative and 2.3% in the historical cohort).
Researchers also found male sex, Black race and older age (>50 years) were risk factors for AKI, while male sex and older age were associated with the composite outcome of RRT or mortality, regardless of COVID-19 status.
“An interesting observation was worse outcomes in the COVID-19–negative group compared with the historical cohort,” Fisher and colleagues wrote of the findings. “We attribute this difference to a high rate of false-negative tests in the COVID-19–negative group and allocation of resources away from patients without COVID-19 to those with or suspected of having COVID-19. Furthermore, there was community avoidance of the hospital setting during this time period due to concern for contracting COVID-19, thus those presenting to the hospital during the COVID-19 crisis were likely more severely ill.”
Researchers concluded that this study highlights the burden of AKI on hospital systems during the pandemic.
Collapse
Read more about
Click Here to Manage Email Alerts