Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: An international multi-centre observational cohort study

Byorn W L Tan , Bryce W Q Tan , Amelia L M Tan , Emily R Schriver , Alba Gutierrez-Sacristan , Priyam Das , William Yuan , Meghan R Hutch , Noelia Garcia Barrio , Miguel Pedrera Jimenez , Noor Abu-El-Rub , Michele Morris , Bertrand Moal , Guillaume Verdy , Kelly Cho , Yuk-Lam Ho , Lav P Patel , Arianna Dagliati , Antoine Neuraz , Jeffrey G Klann , Andrew M South , Shyam Visweswaran , David A Hanauer , Sarah E Maidlow , Mei Liu , Danielle L Mowery , Ashley Batugo , Adeline Makoudjou , Patric Tippmann , Daniela Zoller , Gabriel A Brat , Yuan Luo , Paul Avillach , Riccardo Bellazzi , Luca Chiovato , Alberto Malovini , Valentina Tibollo , Malarkodi Jebathilagam Samayamuthu , Pablo Serrano Balazote , Zongqi Xia , Ne Hooi Will Loh , Lorenzo Chiudinelli , Clara-Lea Bonzel , Chuan Hong , Harrison G Zhang , Griffin M Weber , Isaac S Kohane , Tianxi Cai , Gilbert S Omenn , John H Holmes , Kee Yuan Ngiam , Romain Griffier (1) , Vianney Jouhet (1)

1 BPH - Bordeaux population health

BACKGROUND: While acute kidney injury (AKI) is a common complication in COVID-19, data on post-AKI kidney function recovery and the clinical factors associated with poor kidney function recovery is lacking. METHODS: A retrospective multi-centre observational cohort study comprising 12,891 hospitalized patients aged 18 years or older with a diagnosis of SARS-CoV-2 infection confirmed by polymerase chain reaction from 1 January 2020 to 10 September 2020, and with at least one serum creatinine value 1-365 days prior to admission. Mortality and serum creatinine values were obtained up to 10 September 2021. FINDINGS: Advanced age (HR 2.77, 95%CI 2.53-3.04, p < 0.0001), severe COVID-19 (HR 2.91, 95%CI 2.03-4.17, p < 0.0001), severe AKI (KDIGO stage 3: HR 4.22, 95%CI 3.55-5.00, p < 0.0001), and ischemic heart disease (HR 1.26, 95%CI 1.14-1.39, p < 0.0001) were associated with worse mortality outcomes. AKI severity (KDIGO stage 3: HR 0.41, 95%CI 0.37-0.46, p < 0.0001) was associated with worse kidney function recovery, whereas remdesivir use (HR 1.34, 95%CI 1.17-1.54, p < 0.0001) was associated with better kidney function recovery. In a subset of patients without chronic kidney disease, advanced age (HR 1.38, 95%CI 1.20-1.58, p < 0.0001), male sex (HR 1.67, 95%CI 1.45-1.93, p < 0.0001), severe AKI (KDIGO stage 3: HR 11.68, 95%CI 9.80-13.91, p < 0.0001), and hypertension (HR 1.22, 95%CI 1.10-1.36, p = 0.0002) were associated with post-AKI kidney function impairment. Furthermore, patients with COVID-19-associated AKI had significant and persistent elevations of baseline serum creatinine 125% or more at 180 days (RR 1.49, 95%CI 1.32-1.67) and 365 days (RR 1.54, 95%CI 1.21-1.96) compared to COVID-19 patients with no AKI. INTERPRETATION: COVID-19-associated AKI was associated with higher mortality, and severe COVID-19-associated AKI was associated with worse long-term post-AKI kidney function recovery. FUNDING: Authors are supported by various funders, with full details stated in the acknowledgement section.

Mots clés: Acute kidney injury; COVID-19; Chronic kidney disease; Electronic health records; SARS-CoV-2

Domaines: Santé publique et épidémiologie

Byorn W L Tan, Bryce W Q Tan, Amelia L M Tan, Emily R Schriver, Alba Gutierrez-Sacristan, et al.. Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: An international multi-centre observational cohort study. EClinicalMedicine, 2023, 55, pp.101724. ⟨10.1016/j.eclinm.2022.101724⟩. ⟨hal-04574714⟩