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Changes of Acute Kidney Injury Epidemiology during the COVID-19 Pandemic: A Retrospective Cohort Study
Pasquale Esposito1,2, Elisa Russo1, Daniela Picciotto1
1Unit of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy.
Insights
The COVID-19 pandemic significantly increased acute kidney injury (AKI) rates in hospitalized patients, affecting both those with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This highlights the need for revised AKI management strategies during health emergencies.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- The Coronavirus Disease-19 (COVID-19) pandemic has profoundly impacted healthcare systems globally.
- Understanding its effect on acute kidney injury (AKI) epidemiology is crucial for patient care and public health preparedness.
Purpose of the Study:
- To assess the changes in in-hospital acute kidney injury (AKI) incidence and outcomes during the COVID-19 pandemic compared to the pre-pandemic era.
- To investigate the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the pandemic period with AKI development.
Main Methods:
- A retrospective cohort study comparing hospitalized patients from January 2016–December 2019 (pre-COVID-19) and January–December 2020 (COVID-19 period).
- AKI was diagnosed based on creatinine level kinetics.
- Multivariate analysis was used to identify independent predictors of AKI and mortality.
Main Results:
- The COVID-19 period saw a higher incidence of AKI (31.7%) compared to the pre-COVID-19 period (25.9%), with higher rates in SARS-CoV-2 positive patients (42.2%).
- AKI development was independently associated with SARS-CoV-2 infection and the admission period.
- Patients admitted during the COVID-19 period experienced worse clinical outcomes, including increased ICU admission, longer hospital stays, and higher mortality, independently linked to the pandemic and SARS-CoV-2 infection.
Conclusions:
- The COVID-19 pandemic altered the epidemiology of in-hospital AKI, affecting both COVID-19 positive and negative patients.
- These findings necessitate a re-evaluation of AKI management protocols, particularly during widespread health emergencies.
Abstract:
To evaluate the impact of the Coronavirus Disease-19 (COVID-19) pandemic on the epidemiology of acute kidney injury (AKI) in hospitalized patients, we performed a retrospective cohort study comparing data of patients hospitalized from January 2016 to December 2019 (pre-COVID-19 period) and from January to December 2020 (COVID-19 period, including both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative and positive patients). AKI was classified by evaluating the kinetics of creatinine levels. A total of 51,681 patients during the pre-COVID-19 period and 10,062 during the COVID-19 period (9026 SARS-CoV-2-negative and 1036 SARS-CoV-2-positive) were analyzed. Patients admitted in the COVID-19 period were significantly older, with a higher prevalence of males. In-hospital AKI incidence was 31.7% during the COVID-19 period (30.5% in SARS-CoV-2-negative patients and 42.2% in SARS-CoV-2-positive ones) as compared to 25.9% during the pre-COVID-19 period (p < 0.0001). In the multivariate analysis, AKI development was independently associated with both SARS-CoV-2 infection and admission period. Moreover, evaluating the pre-admission estimated glomerular filtration rate (eGFR) we found that during the COVID-19 period, there was an increase in AKI stage 2−3 incidence both in patients with pre-admission eGFR < 60 mL/min/1.73 m2 and in those with eGFR ≥ 60 mL/min/1.73 m2 (“de novo” AKI). Similarly, clinical outcomes evaluated as intensive care unit admission, length of hospital stay, and mortality were significantly worse in patients admitted in the COVID-19 period. Additionally, in this case, the mortality was independently correlated with the admission during the COVID-19 period and SARS-CoV-2 infection. In conclusion, we found that during the COVID-19 pandemic, in-hospital AKI epidemiology has changed, not only for patients affected by COVID-19. These modifications underline the necessity to rethink AKI management during health emergencies.
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