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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
COVID-19-Associated Acute Kidney Injury and Longitudinal Kidney Outcomes
Abinet M Aklilu1,2, Sanchit Kumar1, James Nugent1,3
1Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut.
Insights
Survivors of COVID-19-associated acute kidney injury (AKI) had better long-term kidney outcomes. This study found lower rates of major adverse kidney events (MAKE) and mortality in COVID-AKI patients compared to other AKI groups.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- COVID-19 is linked to a high incidence of acute kidney injury (AKI).
- Long-term kidney function after COVID-19-associated AKI (COVID-AKI) is not well understood.
- Previous reports indicate rapid kidney function decline in the initial months post-COVID-AKI.
Purpose of the Study:
- To evaluate the long-term kidney outcomes for patients who experienced COVID-AKI.
- To compare major adverse kidney events (MAKE) in COVID-AKI survivors versus other AKI cohorts.
Main Methods:
- Retrospective longitudinal multicenter cohort study using electronic health records.
- Included hospitalized adult patients with AKI during the pandemic (COVID-AKI) and a historical influenza-associated AKI cohort.
- Follow-up for up to 2 years post-discharge, analyzing MAKE (mortality, eGFR decline, or kidney failure).
Main Results:
- The study analyzed 9624 patients with AKI, including 987 with COVID-AKI.
- COVID-AKI patients had lower rates of MAKE compared to other-AKI (aHR, 0.67) and influenza-AKI groups.
- This reduction in MAKE was driven by lower all-cause mortality (aHR, 0.31) and worsened kidney function (aHR, 0.78).
Conclusions:
- Hospitalized patients surviving COVID-AKI show a lower incidence of long-term adverse kidney outcomes.
- COVID-AKI survivors experienced significantly reduced rates of mortality and kidney function decline compared to other AKI groups.
- Findings suggest a potentially better long-term renal prognosis for COVID-AKI survivors than initially feared.
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.
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