The Prevalence and Short-term Outcomes of Acute Kidney Injury in Patients Hospitalized With Covid-19 Infection

Abstract

Background: Acute Kidney Injury is common among COVID-19 patients and is associated with adverse outcomes. This study aims to determine the prevalence and short-term outcomes of AKI among admitted COVID-19 patients, as this is not well documented in East Africa. Methods: Retrospective cohort study of patients hospitalized in a private facility in Nairobi between 1st January and 31st December 2021. We included all PCR positive COVID-19 patients ≥ 18 years with ≥ 2 creatinine levels. Patients with confirmed ESRD at admission or on chronic RRT before admission were excluded. AKI and its severity were defined using KDIGO, and short-term outcomes at discharge were in hospital death and renal recovery. Descriptive statistics were used to profile patient characteristics. Non-AKI and AKI groups compared using Mann- Whitney and Kruskal- Wallis test, and chi-square test for continuous and categorical variables respectively. Multivariable logistic regression used to test association of AKI with presence of selected risk factors. Prior to that, a bivariable logistic regression was fit for each of the predictor variables and only included in the multivariable logistic regression if the predictor variables had a p-value ≤ 0.20 with exception of age, sex and race as possible confounders. P<0.05 was considered statistically significant. Results: Of the 365 eligible patients, majority were male (61.4%) aged ≥ 50 years. AKI developed in 74 (20.3%) patients with 52.7%, 18.9% and 28.4% in stages 1, 2 and 3 respectively. Of these 13.5% needed RRT, 32 (43.2%) were admitted to ICU, 18 (24%) were ventilated, 24.3% died and 75.7% were discharged. Of the AKI survivors, 42 (75%) achieved full renal recovery at discharge. AKI risk factors were older age (OR 1.046 p<0.001), male sex (OR 2.490 p 0.002), multiple comorbidities (OR 3.694 p 0.001), hypertension (OR 2.598 p 0.001), diabetes mellitus (OR 2.586 p<0.001) and pre-existing CKD (OR 10.550 p<0.001). Conclusions: AKI in hospitalized COVID-19 patients is common. The prevalence is predominantly higher in critically ill patients and is associated with a higher chance of mortality. Majority of the patients have mild disease with most of them achieving full renal recovery at discharge.