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Geographic and Temporal Trends in COVID-Associated Acute Kidney Injury in the National COVID Cohort Collaborative

Yun J Yoo1, Kenneth J Wilkins2,3, Fadhl Alakwaa4

  • 1Department of Biology, Stony Brook University, Stony Brook, New York.

Clinical Journal of the American Society of Nephrology : CJASN
|May 3, 2023
PubMed

Insights

The incidence of Acute Kidney Injury (AKI) in hospitalized COVID-19 patients varied significantly by region and time, with higher mortality observed in AKI patients. These trends evolved throughout the pandemic in the United States.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Public Health

Background:

  • Acute Kidney Injury (AKI) is a known risk factor for mortality in patients hospitalized with coronavirus disease 2019 (COVID-19).
  • However, comprehensive data on the incidence, geographic distribution, and temporal trends of AKI in this population since the pandemic's onset remain limited.

Purpose of the Study:

  • To investigate the incidence, geographic variations, and temporal changes of AKI in hospitalized COVID-19 patients in the United States.
  • To analyze the association between AKI and mortality in this cohort.

Main Methods:

  • Utilized electronic health record data from the National COVID Cohort Collaborative (N3C) for hospitalized adults with COVID-19 (March 2020 - January 2022).
  • AKI was identified using serum creatinine levels and diagnosis codes.
  • Data were analyzed across 16-week periods and four geographic regions (Northeast, Midwest, South, West) using multivariable models.

Main Results:

  • Out of 336,473 patients, 38% were diagnosed with AKI. An additional 17% had AKI based on creatinine changes without a diagnosis code, also showing higher mortality.
  • AKI incidence peaked in the initial period (47%) and decreased thereafter.
  • The South and West regions consistently showed higher adjusted odds of AKI compared to the Midwest, particularly in later periods.

Conclusions:

  • The incidence and geographic distribution of COVID-19-associated AKI have shifted since the pandemic's initial wave.
  • AKI, regardless of diagnostic method, is significantly associated with increased mortality in hospitalized COVID-19 patients.
Abstract

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