Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Tyler Pitre; Angela Hong Tian Dong; Aaron Jones; Jessica Kapralik; Sonya Cui; Jasmine Mah; Wryan Helmeczi; Johnny Su; Vivek Patel; Zaka Zia; Michael Mallender; Xinxin Tang; Cooper Webb; Nivedh Patro; Mats Junek; MyLinh Duong; Terence Ho; Marla K Beauchamp; Andrew P Costa; Rebecca Kruisselbrink; Jennifer L Y Tsang; Michael Walsh

doi:10.1177/20543581211027759

Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Can J Kidney Health Dis. 2021 Jul 11:8:20543581211027759. doi: 10.1177/20543581211027759. eCollection 2021.

Authors

Tyler Pitre^{1

2}, Angela Hong Tian Dong², Aaron Jones^{2

3}, Jessica Kapralik¹, Sonya Cui², Jasmine Mah⁴, Wryan Helmeczi⁵, Johnny Su⁶, Vivek Patel², Zaka Zia², Michael Mallender², Xinxin Tang², Cooper Webb², Nivedh Patro², Mats Junek¹, MyLinh Duong¹, Terence Ho¹, Marla K Beauchamp⁷, Andrew P Costa^{1

3}, Rebecca Kruisselbrink^{1

2}, Jennifer L Y Tsang^{2

8

9}, Michael Walsh^{3

8

10}

Affiliations

¹ Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
² Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Department of Medicine, Dalhousie University, Halifax, NS, Canada.
⁵ Department of Internal Medicine, University of Ottawa, ON, Canada.
⁶ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
⁷ School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
⁸ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁹ Departmet of Medicine, Niagara Health, St. Catharines, ON, Canada.
¹⁰ Population Health Research Institute, Hamilton Health Sciences/McMaster University, ON, Canada.

Abstract

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population.

Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI.

Design: Retrospective cohort study from a registry of patients with COVID-19.

Setting: Three community and 3 academic hospitals.

Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021.

Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality.

Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality.

Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]).

Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences.

Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification.

Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

Keywords: COVID-19; Canada; KDIGO; acute kidney injury; severity.