Original Investigation
February 26, 2024
COVID-19−Associated Acute Kidney Injury and Longitudinal Kidney Outcomes
Abinet M. Aklilu, Sanchit Kumar, James Nugent, et al
JAMA Intern Med. Published online February 26, 2024. doi:10.1001/jamainternmed.2023.8225
Question Are hospitalized patients who develop acute kidney injury (AKI) associated with COVID-19 at risk of worse kidney function trajectory and higher mortality than those with AKI associated with other illnesses?
Findings This multicenter cohort study using electronic health records of 9624 hospitalized patients with AKI found that patients with COVID-19−associated AKI had a 33% lower risk of major adverse kidney events with 22% lower risk of worsened kidney function and 69% lower risk of mortality compared with those with AKI due to other illnesses.
Meaning These findings indicate that survivors of hospitalization with COVID-19−associated AKI have a significantly lower risk of long-term kidney function decline and all-cause mortality than those with AKI associated with other illnesses.
Abstract
Importance COVID-19 infection is associated with a high incidence of acute kidney injury (AKI). Although rapid kidney function decline has been reported in the first few months after COVID-19−associated AKI (COVID-AKI), the longer-term association of COVID-AKI with kidney function remains unknown.
Objective To assess long-term kidney outcomes of patients who had COVID-19−associated AKI.
Design, Setting, and Participants This was a retrospective longitudinal multicenter cohort study conducted in a large hospital system using electronic health records data on adult hospitalized patients with AKI and COVID-19 or other illnesses. Included patients were hospitalized during the COVID-19 pandemic (March 2020-June 2022), were screened for SARS-CoV-2, had AKI, and survived to discharge, or had been hospitalized during the 5 years before the pandemic (October 2016-January 2020), had a positive influenza A or B test result, had AKI, and survived to discharge. Patients were followed up for a maximum of 2 years after hospital discharge. Data analyses were performed from December 2022 to November 2023.
Exposure COVID-19 and influenza.
Main Outcomes and Measures The primary outcome was major adverse kidney events (MAKE), defined as a composite of mortality and worsened kidney function (estimated glomerular filtration rate [eGFR] decline by ≥25% from discharge eGFR or kidney failure requiring dialysis). Multivariable time-to-event analyses were performed to compare MAKE between individuals with COVID-AKI and those who had AKI associated with other illnesses hospitalized during the same period. For further comparison, this outcome was assessed for a historic cohort of patients with influenza-associated AKI.
Results The study cohort included 9624 hospitalized patients (mean [SD] age, 69.0 [15.7] years; 4955 [51.5%] females) with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI associated with other illnesses (other-AKI). Compared with the other 2 groups, patients with COVID-19−associated AKI were slightly younger in age, had a higher baseline eGFR, worse baseline comorbidity scores, higher markers of illness severity, and longer hospital stay. Compared with the other-AKI group, the COVID-AKI group had lower MAKE (adjusted hazard ratio [aHR], 0.67; 95% CI, 0.59-0.75) due to lower all-cause mortality (aHR, 0.31; 95% CI, 0.24-0.39) and lower rates of worsened kidney function (aHR, 0.78; 95% CI, 0.69-0.88).
Conclusions and Relevance The findings of this multicenter cohort study indicate that survivors of hospitalization with COVID-AKI experience lower rates of MAKE, long-term kidney function decline, and mortality compared with patients with AKI associated with other illnesses.
