Patients with AKI related to COVID-19 require close monitoring after hospital discharge
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For hospitalized patients who developed AKI, those who also had COVID-19 experienced faster rates of kidney function decline following discharge, regardless of baseline comorbidities or AKI severity.
Due to this finding, researchers advocate for the close follow-up of these patients after hospitalization.
“Although the acute effects of COVID-19 on kidney function have been studied, the intermediate- and long-term kidney outcomes after COVID-19–associated AKI remain unknown,” James Nugent, MD, MPH, of Yale University School of Medicine, and colleagues wrote. “Early follow-up of COVID-19 survivors with AKI has shown that 32% of patients had not yet recovered baseline kidney function at a median of 21 days after hospital discharge. Because the high incidence of COVID-19–associated AKI has strained health care delivery systems with limited dialysis resources, understanding the chronic kidney sequelae in this population has important public health implications for resource allocation, CKD screening, and patient counseling.”
For the study, researchers assessed eGFR trajectories for patients who developed AKI after being admitted to a hospital in the Yale New Haven Health System between March and August 2020 (182 patients had AKI related to COVID-19; 1,430 patients had AKI but not COVID-19). Of the study population, researchers noted those with AKI associated with COVID-19 were more likely to be Black (40.1% vs. 15.7%) or Hispanic (22% vs. 8.8%); and also had fewer comorbidities than those without COVID-19 but similar rates of preexisting chronic kidney disease and hypertension.
At the time of hospital discharge, researchers observed that while most patients (with or without COVID-19) had recovered from AKI (82.4% vs. 79.9%), outcomes differed between patients who did not achieve recovery by discharge. More specifically, patients with AKI associated with COVID-19 recovered more slowly after discharge, while also experiencing a lower rate of kidney recovery during outpatient follow-up (adjusted hazard ratio = 0.57).
Regarding differences in eGFR, results showed the unadjusted mean rate of eGFR decline was -11.3 mL/min/1.73 m2 faster per year for patients who also had COVID-19; after adjusting for baseline demographic characteristics and comorbidities, researchers found this difference in eGFR slope persisted (-12.4 mL/min/m2 per year).
After further adjusting for peak serum creatinine levels and dialysis requirements, patients with AKI associated with COVID-19 “continued to show an increased rate of eGFR decrease” (-14 mL/min/1.73 m2 per year).
“Because patients with COVID-19 develop more severe AKI compared with those without COVID-19, patients with COVID-19–associated AKI may be expected to have a faster eGFR decrease after discharge, as we observed in our study population, independent of a patient’s underlying comorbidities” Nugent and colleagues wrote. “The persistence of this outcome after adjusting for AKI severity, represented by peak creatinine levels and the need for dialysis, suggests that the accelerated eGFR decrease may be mediated by other markers of AKI severity, additional hospitalization-related exposures associated with eGFR decrease, the hyperinflammatory state associated with COVID-19, or residual direct effects of SARS-CoV-2.”
According to the researchers, the primary strength of the study was including a comparison group of patients who had AKI but not COVID-19; this, they contended, allowed “for testing of the hypothesis that COVID-19–associated AKI displays not only unique clinical and pathologic features, but also distinct sequelae from other causes of AKI.
“Optimizing blood pressure control, reconciling medications to avoid nephrotoxins, and evaluating indications for renin-angiotensin-aldosterone system blockade may be opportunities to slow disease progression in early outpatient follow-up,” they concluded.
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