Long-term outcomes after AKI in hospitalized patients with COVID-19

Abstract

Introduction and objectives

Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19.

Material and methods

Single-center and retrospective study of hospitalized patients admitted to a Dedicated Unit for COVID-19 at Centro Hospitalar Universitário Lisboa Norte, Portugal, between March 2020 and October 2020. AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, using SCr criteria. The analyzed outcomes were development of major adverse kidney events (MAKE), major adverse renal cardiovascular events (MARCE), and mortality over a two-year follow-up period.

Results

From the included 409 patients, AKI occurred in 60.4% (n = 247). Within two years after discharge, 31.8% (n = 130) of patients had an eGFR < 60 mL/min/1.73 m² and/or a 25% decrease on eGFR and 1.7% (n = 7) of patients required RRT, 6.1% (n = 25) of patients had CV events and 27.9% (n = 114) of patients died. The incidence of MAKE was 60.9% (n = 249), and MARCE was 62.6% (n = 256). On a multivariate analysis, older age (adjusted HR 1.02 (95% CI: 1.01–1.04), p = 0.008), cardiovascular disease (adjusted HR 2.22 (95% CI: 1.24–3.95), p = 0.007), chronic kidney disease (adjusted HR 5.15 (95% CI: 2.22–11.93), p < 0.001), and AKI (adjusted HR 1.76 (95% CI: 1.12–2.78), p = 0.015) were independent predictors of MAKE. Older age (adjusted HR 1.06 (95% CI: 1.04–1.08), p < 0.001) and neoplasia (adjusted HR 4.88 (95% CI: 2.37–10.04), p < 0.001) were independent predictors of mortality.

Conclusions

In this cohort of hospitalized patients with COVID-19, AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and/or mortality after hospital discharge.