Long-term outcomes after AKI in hospitalized patients with COVID-19

Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19.

Single-center and retrospective study of hospitalized patients admitted to a Dedicated Unit for COVID-19 at Centro Hospitalar Universitário Lisboa Norte, Portugal, between March 2020 and October 2020. AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, using SCr criteria. The analyzed outcomes were development of major adverse kidney events (MAKE), major adverse renal cardiovascular events (MARCE), and mortality over a two-year follow-up period.

From the included 409 patients, AKI occurred in 60.4% (n=247). Within two years after discharge, 31.8% (n=130) of patients had an eGFR<60mL/min/1.73m² and/or a 25% decrease on eGFR and 1.7% (n=7) of patients required RRT, 6.1% (n=25) of patients had CV events and 27.9% (n=114) of patients died. The incidence of MAKE was 60.9% (n=249), and MARCE was 62.6% (n=256). On a multivariate analysis, older age (adjusted HR 1.02 (95% CI: 1.01-1.04), p=0.008), cardiovascular disease (adjusted HR 2.22 (95% CI: 1.24-3.95), p=0.007), chronic kidney disease (adjusted HR 5.15 (95% CI: 2.22-11.93), p<0.001), and AKI (adjusted HR 1.76 (95% CI: 1.12-2.78), p=0.015) were independent predictors of MAKE. Older age (adjusted HR 1.06 (95% CI: 1.04-1.08), p<0.001) and neoplasia (adjusted HR 4.88 (95% CI: 2.37-10.04), p<0.001) were independent predictors of mortality.

In this cohort of hospitalized patients with COVID-19, AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and/or mortality after hospital discharge.