Impact of hospital-acquired acute kidney injury on Covid-19 outcomes in patients with and without chronic kidney disease: a multicenter retrospective cohort study

Authors: SAVAŞ ÖZTÜRK, KENAN TURGUTALP, MUSTAFA ARICI, HAKKI ÇETİNKAYA, MEHMET RIZA ALTIPARMAK, ZEKİ AYDIN, ZEKİ SOYPAÇACI, FEYZA BORA, EKREM KARA, EGEMEN CEBECİ, TUBA ELİF ÖZLER, MÜRŞİDE ESRA DÖLARSLAN, SAVAŞ SİPAHİ, YAVUZ AYAR, İDRİS ŞAHİN, SERKAN BAKIRDÖĞEN, MAHMUD İSLAM, NUMAN GÖRGÜLÜ, MELİKE BETÜL ÖĞÜTMEN, ERKAN ŞENGÜL, ÖZKAN GÜNGÖR, NURHAN SEYAHİ, BÜLENT TOKGÖZ, ALİ RIZA ODABAŞ, HALİL ZEKİ TONBUL, SİREN SEZER, ALAATTİN YILDIZ, KENAN ATEŞ

Abstract: Background/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data investigating the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. Materials and methods: HA-AKI development was assessed in a group of stage 3-5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. Results: Among 621 hospitalized patients (age 60 [IQR: 47-73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4%, and stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas it developed in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1% compared to 14.3% of patients with HA-AKI but no CKD (p < 0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate to patients with CKD without AKI. Adjusted mortality risks of the AKI+non-CKD group (HR: 9.0, 95% CI: 1.9-44.2) and AKI+CKD group (HR: 7.9, 95% CI: 1.9-33.3) were significantly higher than that of the non-AKI+non-CKD group. Conclusion: AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcomes whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.

Keywords: Acute kidney injury, chronic kidney disease, Covid-19, hospitalization, mortality

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