TY - JOUR
T1 - Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury
T2 - An international multi-centre observational cohort study
AU - The Consortium for Clinical Characterization of COVID-19 by EHR (4CE)
AU - Tan, Byorn W.L.
AU - Tan, Bryce W.Q.
AU - Tan, Amelia L.M.
AU - Schriver, Emily R.
AU - Gutiérrez-Sacristán, Alba
AU - Das, Priyam
AU - Yuan, William
AU - Hutch, Meghan R.
AU - García Barrio, Noelia
AU - Pedrera Jimenez, Miguel
AU - Abu-el-rub, Noor
AU - Morris, Michele
AU - Moal, Bertrand
AU - Verdy, Guillaume
AU - Cho, Kelly
AU - Ho, Yuk Lam
AU - Patel, Lav P.
AU - Dagliati, Arianna
AU - Neuraz, Antoine
AU - Klann, Jeffrey G.
AU - South, Andrew M.
AU - Visweswaran, Shyam
AU - Hanauer, David A.
AU - Maidlow, Sarah E.
AU - Liu, Mei
AU - Mowery, Danielle L.
AU - Batugo, Ashley
AU - Makoudjou, Adeline
AU - Tippmann, Patric
AU - Zöller, Daniela
AU - Brat, Gabriel A.
AU - Luo, Yuan
AU - Avillach, Paul
AU - Bellazzi, Riccardo
AU - Chiovato, Luca
AU - Malovini, Alberto
AU - Tibollo, Valentina
AU - Samayamuthu, Malarkodi Jebathilagam
AU - Serrano-Balazote, Pablo
AU - Xia, Zongqi
AU - Loh, Ne Hooi Will
AU - Chiudinelli, Lorenzo
AU - Bonzel, Clara Lea
AU - Hong, Chuan
AU - Zhang, Harrison G.
AU - Weber, Griffin M.
AU - Kohane, Isaac S.
AU - Cai, Tianxi
AU - Omenn, Gilbert S.
AU - Boeker, Martin
N1 - Publisher Copyright:
© 2022
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: While acute kidney injury (AKI) is a common complication in COVID-19, data on post-AKI kidney function recovery and the clinical factors associated with poor kidney function recovery is lacking. Methods: A retrospective multi-centre observational cohort study comprising 12,891 hospitalized patients aged 18 years or older with a diagnosis of SARS-CoV-2 infection confirmed by polymerase chain reaction from 1 January 2020 to 10 September 2020, and with at least one serum creatinine value 1–365 days prior to admission. Mortality and serum creatinine values were obtained up to 10 September 2021. Findings: Advanced age (HR 2.77, 95%CI 2.53–3.04, p < 0.0001), severe COVID-19 (HR 2.91, 95%CI 2.03–4.17, p < 0.0001), severe AKI (KDIGO stage 3: HR 4.22, 95%CI 3.55–5.00, p < 0.0001), and ischemic heart disease (HR 1.26, 95%CI 1.14–1.39, p < 0.0001) were associated with worse mortality outcomes. AKI severity (KDIGO stage 3: HR 0.41, 95%CI 0.37–0.46, p < 0.0001) was associated with worse kidney function recovery, whereas remdesivir use (HR 1.34, 95%CI 1.17–1.54, p < 0.0001) was associated with better kidney function recovery. In a subset of patients without chronic kidney disease, advanced age (HR 1.38, 95%CI 1.20–1.58, p < 0.0001), male sex (HR 1.67, 95%CI 1.45–1.93, p < 0.0001), severe AKI (KDIGO stage 3: HR 11.68, 95%CI 9.80–13.91, p < 0.0001), and hypertension (HR 1.22, 95%CI 1.10–1.36, p = 0.0002) were associated with post-AKI kidney function impairment. Furthermore, patients with COVID-19-associated AKI had significant and persistent elevations of baseline serum creatinine 125% or more at 180 days (RR 1.49, 95%CI 1.32–1.67) and 365 days (RR 1.54, 95%CI 1.21–1.96) compared to COVID-19 patients with no AKI. Interpretation: COVID-19-associated AKI was associated with higher mortality, and severe COVID-19-associated AKI was associated with worse long-term post-AKI kidney function recovery. Funding: Authors are supported by various funders, with full details stated in the acknowledgement section.
AB - Background: While acute kidney injury (AKI) is a common complication in COVID-19, data on post-AKI kidney function recovery and the clinical factors associated with poor kidney function recovery is lacking. Methods: A retrospective multi-centre observational cohort study comprising 12,891 hospitalized patients aged 18 years or older with a diagnosis of SARS-CoV-2 infection confirmed by polymerase chain reaction from 1 January 2020 to 10 September 2020, and with at least one serum creatinine value 1–365 days prior to admission. Mortality and serum creatinine values were obtained up to 10 September 2021. Findings: Advanced age (HR 2.77, 95%CI 2.53–3.04, p < 0.0001), severe COVID-19 (HR 2.91, 95%CI 2.03–4.17, p < 0.0001), severe AKI (KDIGO stage 3: HR 4.22, 95%CI 3.55–5.00, p < 0.0001), and ischemic heart disease (HR 1.26, 95%CI 1.14–1.39, p < 0.0001) were associated with worse mortality outcomes. AKI severity (KDIGO stage 3: HR 0.41, 95%CI 0.37–0.46, p < 0.0001) was associated with worse kidney function recovery, whereas remdesivir use (HR 1.34, 95%CI 1.17–1.54, p < 0.0001) was associated with better kidney function recovery. In a subset of patients without chronic kidney disease, advanced age (HR 1.38, 95%CI 1.20–1.58, p < 0.0001), male sex (HR 1.67, 95%CI 1.45–1.93, p < 0.0001), severe AKI (KDIGO stage 3: HR 11.68, 95%CI 9.80–13.91, p < 0.0001), and hypertension (HR 1.22, 95%CI 1.10–1.36, p = 0.0002) were associated with post-AKI kidney function impairment. Furthermore, patients with COVID-19-associated AKI had significant and persistent elevations of baseline serum creatinine 125% or more at 180 days (RR 1.49, 95%CI 1.32–1.67) and 365 days (RR 1.54, 95%CI 1.21–1.96) compared to COVID-19 patients with no AKI. Interpretation: COVID-19-associated AKI was associated with higher mortality, and severe COVID-19-associated AKI was associated with worse long-term post-AKI kidney function recovery. Funding: Authors are supported by various funders, with full details stated in the acknowledgement section.
KW - Acute kidney injury
KW - COVID-19
KW - Chronic kidney disease
KW - Electronic health records
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85141512399&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2022.101724
DO - 10.1016/j.eclinm.2022.101724
M3 - Article
AN - SCOPUS:85141512399
SN - 2589-5370
VL - 55
JO - eClinicalMedicine
JF - eClinicalMedicine
M1 - 101724
ER -