Clinical characteristics and risk factors associated with acute kidney injury among patients hospitalized with primary COVID-19 infection

Monchai  Siribamrungwong; Kamontip  Chaikomon

Authors

Monchai Siribamrungwong Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Kamontip Chaikomon Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

Keywords:

Acute kidney injury, clinical characteristics, COVID-19, risk factors

Abstract

Background: Coronavirus disease 19 (COVID-19) primarily affects the respiratory system with symptoms ranging from mild to severe. In addition, acute kidney injury (AKI) is an important complication of COVID-19 that causes substantially high morbidity and mortality rates. During the COVID-19 pandemic, public healthcare in Thailand experienced many cases and complications thereof.

Objective: This study aimed to establish the incidence, clinical characteristics, independent risk factors of AKI, and mortality in patients hospitalized with COVID-19 with or without AKI.

Methods: This was a retrospective; observational study performed in Lerdsin Hospital from August 2021 to August 2022. A total of 576 patients who were hospitalized with a diagnosis of COVID-19 infection were analyzed. AKI was diagnosed based on the extended Kidney Disease Global Outcomes criteria. Clinical characteristics were compared between patients with COVID-19 with or without AKI. Furthermore, independent risk factors were reported using adjusted odds ratios (aORs).

Results: One hundred and forty-five patients with COVID-19 developed AKI. The AKI group exhibited a higher proportion of male, older patients, and a higher rate of pneumonia. The independent risk factors were male gender (aOR, 1.8; 95% confidence interval (CI): 1.2–3.0), age ≥ 60 years (aOR, 2.0; 95% CI: 1.2–3.5), chronic kidney disease (aOR, 5.5; 95% CI: 2.0–14.7), coronary artery disease (aOR, 3.3; 95% CI: 1.1–9.2), pneumonia (aOR, 4.0; 95% CI: 1.5–10.5), serum potassium ≥4.5 mEq/L (aOR, 2.3; 95% CI: 1.1–5.0), and serum bicarbonate < 22 mEq/L (aOR, 2.4; 95% CI: 1.3–4.3). Patients with a history of COVID-19 vaccination exhibited a reduced incidence of AKI (aOR, 0.5; 95% CI: 0.3–0.8).

Conclusion: The identified independent risk factors offered predictive potential for the development of AKI. Administration of the COVID-19 vaccine in patients with COVID-19 potentially protected them against AKI.

Downloads

Download data is not yet available.

References

Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, AlJabir A, et al. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71-6.

https://doi.org/10.1016/j.ijsu.2020.02.034

Smith DR. Review a brief history of coronaviruses in Thailand. J Virol Methods. 2021;289:114034.

https://doi.org/10.1016/j.jviromet.2020.114034

Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, et al. AKI in hospitalized patients with COVID-19. J Am Soc Nephrol 2021;32:151-60.

https://doi.org/10.1681/ASN.2020050615

Ng JH, Hirsch JS, Hazzan A, Wanchoo R, Shah HH, Malieckal DA, et al. Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis 2021;77:204-15.e1.

https://doi.org/10.1053/j.ajkd.2020.09.002

Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020;97:829-38.

https://doi.org/10.1016/j.kint.2020.03.005

Mahalingasivam V, Su G, Iwagami M, Davids MR, Wetmore JB, Nitsch D. COVID-19 and kidney disease: Insights from epidemiology to inform clinical practice. Nat Rev Nephrol 2022;18:485-98.

https://doi.org/10.1038/s41581-022-00570-3

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.

https://doi.org/10.1016/S0140-6736(20)30183-5

Yang X, Jin Y, Li R, Zhang Z, Sun R, Chen D. Prevalence and impact of acute renal impairment on COVID-19: a systematic review and meta-analysis. Crit Care 2020;24:356.

https://doi.org/10.1186/s13054-020-03065-4

Uribarri A, Núñez-Gil IJ, Aparisi A, Becerra-Muñoz VM, Feltes G, Trabattoni D, et al. Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID- 19 (Health Outcome Predictive Evaluation for COVID 19) registry. J Nephrol2020;33:737-45.

https://doi.org/10.1007/s40620-020-00790-5

Aggarwal S, Garcia-Telles N, Aggarwal G, Lavie C, Lippi G, Henry BM. Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): early report from the United States. Diagnosis (Berl) 2020;7:9-6.

https://doi.org/10.1515/dx-2020-0046

Sullivan MK, Lees JS, Drake TM, Docherty AB, Oates G, Hardwick HE, et al. Acute kidney injury in patients hospitalized with COVID-19 from the ISARIC WHO CCP-UK Study: A prospective, multicentre cohort study. Nephrol Dial Transplant 2022;37:271-84.

https://doi.org/10.1093/ndt/gfab303

Silver SA, Beaubien-Souligny W, Shah PS, Harel S, Blum D, Kishibe T, et al. The prevalence of acute kidney injury in patients hospitalized with COVID-19 infection: a systematic review and meta-analysis. Kidney Med2021;3:83-98.

https://doi.org/10.1016/j.xkme.2020.11.008

Wan YI, Bien Z, Apea VJ, Orkin CM, Dhairyawan R, Kirwan CJ, et al. Acute kidney injury in COVID-19: multicentre prospective analysis of registry data. Clin Kidney J 2021;14:2356-64.

https://doi.org/10.1093/ckj/sfab071

Lumlertgul N, Pirondini L, Cooney E, Kok W, Gregson J, Camporota L, et al. Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study. Ann Intensive Care 2021;11:123.

https://doi.org/10.1186/s13613-021-00914-5

Hsu CM, Gupta S, Tighiouart H, Goyal N, Faugno AJ, Tariq A, et el. Kidney recovery and death in critically ill patients with COVID- 19-associated acute kidney injury treated with dialysis: the STOP- COVID cohort study. Am J Kidney Dis 2022;79:404-16.e1.

Sarkesh A, Daei Sorkhabi A, Sheykhsaran E, Alinezhad F, Mohammadzadeh N, Hemmat N, et al. Extrapulmonary clinical manifestations in COVID-19 patients. Am J Trop Med Hyg 2020;103:1783-96.

https://doi.org/10.4269/ajtmh.20-0986

Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int 2020;98:219-27.

https://doi.org/10.1016/j.kint.2020.04.003

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844-7.

https://doi.org/10.1111/jth.14768

Legrand M, Bell S, Forni L, Joannidis M, Koyner JL, Liu K, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol 2021;17:751-64.

https://doi.org/10.1038/s41581-021-00452-0

Wainstein M, MacDonald S, Fryer D, Young K, Balan V, Begum H, et al. Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: a multinational study using the ISARIC-WHO clinical characterisation protocol. PLoS Med 2022;19:e1003969.

https://doi.org/10.1371/journal.pmed.1003969

Raina R, Mahajan ZA, Vasistha P, Chakraborty R, Mukunda K, Tibrewal A, et al. Incidence and outcomes of acute kidney injury in COVID-19: a systematic review. Blood Purif 2022;51:199-212.

https://doi.org/10.1159/000514940

Zhang J, Pang Q, Zhou T, Meng J, Dong X, Wang Z, et al. Risk factors for acute kidney injury in COVID-19 patients: an updated systematic review and metaanalysis. Ren Fail 2023;45:2170809.

https://doi.org/10.1080/0886022X.2023.2170809

Hidayat AA, Gunawan VA, Iragama FR, Alfiansyah R, Hertanto DM, Tjempakasari A, et al. Risk factors and clinical characteristics of acute kidney injury in patients with COVID-19: a systematic review and meta-analysis. Pathophysiol 2023;30:233-47.

https://doi.org/10.3390/pathophysiology30020020

Scully EP, Haverfield J, Ursin RL, Tannenbaum C, Klein SL. Considering how biological sex impacts immune responses and COVID-19 outcomes. Nat Rev Immunol 2020;20:442-7.

https://doi.org/10.1038/s41577-020-0348-8

Meng Y, Wu P, Lu W, Liu K, Ma K, Huang L, et al. Sex-specific clinical characteristics and prognosis of coronavirus disease-19 infection in Wuhan, China: a retrospective study of 168 severe patients. PLoS Pathog. 2020;16:e1008520.

https://doi.org/10.1371/journal.ppat.1008520

Zhang B, Zhou X, Qiu Y, Song Y, Feng F, Feng J, et al. Clinical characteristics of 82 cases of death from COVID-19. PLoS One. 2020;15:e0235458.

https://doi.org/10.1371/journal.pone.0235458

Lukowsky LR, Der-Martirosian C, Northcraft H, Kalantar-Zadeh K, Goldfarb DS, Dobalian A. Predictors of acute kidney injury (AKI) among COVID-19 patients at the US Department of Veterans Affairs: the important role of COVID-19 vaccinations. Vaccines (Basel) 2024; 12:146.

https://doi.org/10.3390/vaccines12020146

Martínez-Sánchez FD, Bastida-Castro LA, TorresCuevas JL, Vasquez-Vasquez JA, Diaz-Jarquin A, Moreno-Novales R, et al. COVID-19 and acute kidney injury outcomes in hospitalized patients following SARS-CoV-2 vaccination: a case-control study. Can J Kidney Health Dis 2024;11:20543581241297369.

https://doi.org/10.1177/20543581241297369