Changes of Acute Kidney Injury Epidemiology during the COVID-19 Pandemic: A Retrospective Cohort Study

Pasquale Esposito; Elisa Russo; Daniela Picciotto; Francesca Cappadona; Yuri Battaglia; Giovanni Battista Traverso; Francesca Viazzi

doi:10.3390/jcm11123349

Changes of Acute Kidney Injury Epidemiology during the COVID-19 Pandemic: A Retrospective Cohort Study

J Clin Med. 2022 Jun 10;11(12):3349. doi: 10.3390/jcm11123349.

Authors

Pasquale Esposito^{1

2}, Elisa Russo¹, Daniela Picciotto¹, Francesca Cappadona¹, Yuri Battaglia^{3

4}, Giovanni Battista Traverso¹, Francesca Viazzi^{1

2}

Affiliations

¹ Unit of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy.
² IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy.
³ Department of Medicine, University of Verona, 37134 Verona, Italy.
⁴ Nephrology and Dialysis Unit, Pederzoli Hospital, 37019 Peschiera del Garda, Italy.

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.

Keywords: COVID-19; SARS-CoV-2; acute kidney injury; hospitalization; mortality.

Grants and funding

This research received no external funding.