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AKI in Hospitalized Patients with COVID-19 and Seasonal Influenza: A Comparative Analysis

Bhavna Bhasin1, Vineet Veitla1, Aprill Z Dawson2,3

  • 1Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Kidney360
|April 4, 2022
PubMed

Insights

Acute kidney injury (AKI) occurred in 33% of COVID-19 and influenza hospitalizations. COVID-19 patients had higher risks of severe AKI, with Black race and mechanical ventilation as key risk factors.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) shares similarities with seasonal influenza, including the risk of systemic complications like acute kidney injury (AKI).
  • Understanding the comparative epidemiology of AKI in these distinct viral infections is crucial for clinical management and patient outcomes.

Purpose of the Study:

  • To conduct a comparative analysis of the prevalence, risk factors, and outcomes of AKI in patients hospitalized with COVID-19 versus seasonal influenza.
  • To identify specific predictors for AKI development in each patient cohort.

Main Methods:

  • A retrospective cohort study design was employed, analyzing data from 325 COVID-19 and 433 influenza hospitalizations.
  • Acute kidney injury (AKI) was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
  • Multivariable analysis was utilized to determine independent predictors of AKI, adjusting for baseline characteristics and comorbidities.

Main Results:

  • The incidence of AKI was similar in both cohorts (33%).
  • However, COVID-19-associated AKI (COV-AKI) demonstrated a significantly higher risk of stage 3 AKI (OR, 3.46).
  • Independent risk factors for COV-AKI included mechanical ventilation (OR, 5.85) and Black race, while pre-existing chronic kidney disease (CKD) was a significant risk factor for both COV-AKI and influenza-associated AKI (FLU-AKI).

Conclusions:

  • Pre-existing CKD is a critical risk factor for AKI in both COVID-19 and influenza patients.
  • Mechanical ventilation and Black race are independently associated with an increased risk of COV-AKI, which presents with a higher burden of severe AKI and poorer prognosis.
  • These findings highlight distinct risk profiles and outcomes for AKI in COVID-19 compared to influenza, necessitating tailored clinical approaches.
Abstract

Keywords:
COVID-19acute kidney injuryacute kidney injury and ICU nephrologyinfluenzamortalityrenal replacement therapy

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