tetano
Editor, Senior Moderator
Clin Kidney J
. 2022 Oct 28;16(2):374-383.
doi: 10.1093/ckj/sfac239. eCollection 2023 Feb.
Acute and chronic kidney disease and risk of hospital mortality during COVID-19 pandemic waves in the pre-vaccination era
José Portolés[SUP] 1 2 3 [/SUP], Paula López-Sánchez[SUP] 1 [/SUP], Leyre Martin-Rodríguez[SUP] 1 2 3 [/SUP], María Luisa Serrano-Salazar[SUP] 1 2 [/SUP], Maria Valdenebro-Recio[SUP] 1 2 [/SUP], Antonio Ramos[SUP] 4 [/SUP], Rosa María Malo[SUP] 5 [/SUP], Felipe Zalamea[SUP] 1 2 [/SUP], Juan Manuel Martin-Giner[SUP] 6 [/SUP], María Marques[SUP] 1 2 [/SUP], Alberto Ortiz[SUP] 7 8 [/SUP]
Affiliations
Abstract
Background: Chronic kidney disease (CKD) is a risk factor for death from coronavirus disease 2019 (COVID-19), and COVID-19 may cause acute kidney injury (AKI) which also influences outcomes. There is little information on the independent contribution of CKD and AKI to the risk of death in COVID-19 on different waves, as CKD is a key risk factor for AKI.
Methods: We have studied the epidemiology of CKD and AKI in 2878 patients hospitalized for COVID-19 and their independent association with in-hospital mortality in the two largest pre-vaccination COVID-19 waves in Madrid, Spain. Hospitalized COVID-19 patients were grouped into four mutually exclusive categories: previous-CKD, community-acquired AKI (CA-AKI), hospital-acquired AKI (HA-AKI) and normal renal function throughout hospitalization.
Results: Pre-existent or acquired kidney involvement was observed in 35.5% and 36.8% of COVID-19 patients in the 1st and 3rd waves, respectively. Overall, 13.9% of patients with normal kidney function on arrival developed HA-AKI. In the 3rd wave, CA-AKI was more common than in the 1st wave. Overall, 9%-20% of CKD cases and 22%-40% of AKI cases remained undiagnosed in the discharge report. CKD, CA-AKI and HA-AKI were independently associated with risk of death in multivariate analysis, with HA-AKI, which was usually mild, being the most relevant independent risk factor for in-hospital mortality. A model including kidney involvement category, age, Charlson index, admission lactate dehydrogenase and lymphocytes predicted death with a receiver operating characteristic area under the curve of 0.898.
Conclusion: In conclusion, CKD and AKI were common in pre-vaccination waves among hospitalized COVID-19 patients and were independent risk factors for death, even when AKI was mild to moderate, and despite improvements in treatment.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; chronic kidney disease; epidemiology; mortality.
. 2022 Oct 28;16(2):374-383.
doi: 10.1093/ckj/sfac239. eCollection 2023 Feb.
Acute and chronic kidney disease and risk of hospital mortality during COVID-19 pandemic waves in the pre-vaccination era
José Portolés[SUP] 1 2 3 [/SUP], Paula López-Sánchez[SUP] 1 [/SUP], Leyre Martin-Rodríguez[SUP] 1 2 3 [/SUP], María Luisa Serrano-Salazar[SUP] 1 2 [/SUP], Maria Valdenebro-Recio[SUP] 1 2 [/SUP], Antonio Ramos[SUP] 4 [/SUP], Rosa María Malo[SUP] 5 [/SUP], Felipe Zalamea[SUP] 1 2 [/SUP], Juan Manuel Martin-Giner[SUP] 6 [/SUP], María Marques[SUP] 1 2 [/SUP], Alberto Ortiz[SUP] 7 8 [/SUP]
Affiliations
- PMID: 36751624
- PMCID: PMC9620382
- DOI: 10.1093/ckj/sfac239
Abstract
Background: Chronic kidney disease (CKD) is a risk factor for death from coronavirus disease 2019 (COVID-19), and COVID-19 may cause acute kidney injury (AKI) which also influences outcomes. There is little information on the independent contribution of CKD and AKI to the risk of death in COVID-19 on different waves, as CKD is a key risk factor for AKI.
Methods: We have studied the epidemiology of CKD and AKI in 2878 patients hospitalized for COVID-19 and their independent association with in-hospital mortality in the two largest pre-vaccination COVID-19 waves in Madrid, Spain. Hospitalized COVID-19 patients were grouped into four mutually exclusive categories: previous-CKD, community-acquired AKI (CA-AKI), hospital-acquired AKI (HA-AKI) and normal renal function throughout hospitalization.
Results: Pre-existent or acquired kidney involvement was observed in 35.5% and 36.8% of COVID-19 patients in the 1st and 3rd waves, respectively. Overall, 13.9% of patients with normal kidney function on arrival developed HA-AKI. In the 3rd wave, CA-AKI was more common than in the 1st wave. Overall, 9%-20% of CKD cases and 22%-40% of AKI cases remained undiagnosed in the discharge report. CKD, CA-AKI and HA-AKI were independently associated with risk of death in multivariate analysis, with HA-AKI, which was usually mild, being the most relevant independent risk factor for in-hospital mortality. A model including kidney involvement category, age, Charlson index, admission lactate dehydrogenase and lymphocytes predicted death with a receiver operating characteristic area under the curve of 0.898.
Conclusion: In conclusion, CKD and AKI were common in pre-vaccination waves among hospitalized COVID-19 patients and were independent risk factors for death, even when AKI was mild to moderate, and despite improvements in treatment.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; chronic kidney disease; epidemiology; mortality.