AKI more common in patients with severe acute respiratory syndrome vs COVID-19
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A comparison of patients hospitalized with either severe acute respiratory syndrome or COVID-19 showed the former was associated with a higher prevalence of AKI, as well as major adverse clinical outcomes.
“COVID-19 is not the first human coronavirus disease that has resulted in such global health concern,” Jeremy Yuen-Chen Teoh, MBBS, FRCSEd, FCSHK, FHKAM, of the Chinese University of Hong Kong, and colleagues wrote. “In 2003, the severe acute respiratory syndrome (SARS) outbreak affected 29 countries and resulted in a total of 8,422 patients worldwide. Asian countries were mostly affected during the SARS outbreak, and Hong Kong is one of the few areas suffering from both SARS and COVID-19.”
Due to the impact of both infections on the Hong Kong population, researchers conducted a territory-wide retrospective cohort study in which they considered the burden of AKI and adverse outcomes in patients hospitalized with SARS (March to June 2003; n = 1,670) or COVID-19 (January to May 2020; n = 1,040). The primary endpoint was a composite of ICU admission, use of invasive mechanical ventilation and/or mortality.
Results showed a higher proportion of patients with SARS developed AKI than did those with COVID-19.
More specifically, 7.9%, 2.1% and 3.7% of patients with SARS had stage 1, 2 or 3 AKI, respectively vs. 6.6%, 0.4% and 1.1% of those with COVID-19, respectively.
For both groups, diabetes and hypertension were associated with a significantly increased AKI risk.
Regarding outcomes, researchers observed that 26% of patients hospitalized with SARS met the primary endpoint compared with 5.3% of patients hospitalized with COVID-19, with an association seen between SARS and a higher rate of major adverse clinical outcomes.
“We must emphasize that the association between AKI and the primary endpoint does not imply any causality,” Teoh and colleagues wrote. “In fact, most patients developed AKI after they had met the primary endpoint.”
The researchers noted that, for patients who did not meet the primary endpoint, those with SARS had higher peak creatinine levels and higher stages of AKI than did those with COVID-19.
For both conditions, recovery in kidney function “usually” occurred within 30 days.
“We should remain vigilant in the identification of high-risk patients, and more aggressive treatment may be needed early on,” the researchers concluded. “Serial renal function monitoring may be helpful in detecting any earlier deterioration of the disease.”
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Teoh Yuen-Chen J, et al. J Am Soc Nephrol. 2021;doi:10.1681/ASN.2020071097.
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