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Kidney transplant patients with COVID‑19 are at a higher risk of a severe form of the disease, hospitalization, mortality and acute kidney injury (AKI).
There is little information about the medium-term renal function outcome in those kidney transplant patients who have had COVID‑19.
This paper aims to describe the outcome at 2 years from the diagnosis of COVID‑19 in kidney transplant patients (Ps) developing AKI.
The clinical records of kidney transplant Ps infected with COVID‑19 between May 2020 and November 2021 were reviewed. Severe COVID‑19 was defined as the presence of respiratory failure requiring mechanical ventilation (MV).
The baseline graft function was assessed by estimating the glomerular filtration rate (eGFR), using CKD-EPI and plasma creatinine. Acute kidney injury was classified as per KDIGO.
COVID-19-related mortality was defined when death occurred within 15 days of diagnosis.
In the period assessed, 78 kidney transplant Ps were diagnosed with COVID‑19 and required hospitalization. Gender distribution: 34 men (44%); age: 46.2 (20‑77); overall mortality rate: 20.5% (16 Ps); COVID‑19‑related mortality rate: 11.5% (9 Ps).
AKI was found in 24 Ps (30.77%). When comparing the AKI and non-AKI groups, age was 54 vs. 44 (p < 0.05), respectively, and 15 Ps (62%) in the AKI group were women vs. 19 (35%) in the non-AKI group (p < 0.05). The baseline renal function was as follows: creatinine 1.7 mg/dl vs. 1.5 mg/dl, and CKD-EPI 55.2 ml/min vs. 57.4 ml/min (P=NS). The mortality rate was 41.7% (10 Ps) in the AKI group and 11.1% (6Ps) (P<0.05) in the non-AKI group. The AKI group had more cases of severe COVID‑19, requiring MV: 41.7% (10 Ps) vs. 9.3% (5 Ps) (p < 0.05).
In the AKI group, 7 out of 24 Ps (29.1%) required acute dialysis.
COVID-19‑related mortality affected 7 out of 24 Ps (29.1%) in the AKI group and 2 out of 54 (3.7%) in the non-AKI group (p < 0.05).
Three out of 24 Ps (12.5%) in the AKI group and 3 out of 54 (5.5%) in the non-AKI group developed end-stage chronic disease.
Out of the 56 Ps with a functioning graft at 24-month follow-up, 90.9% (10/11 Ps) of the AKI group and 97.7% (44/45 Ps) of the non-AKI group did not have worsening renal function. For comparison purposes, creatinine and eGFR before COVID‑19 and at 24 months were used.
AKI was a frequent complication in this population and was mainly found in older and female Ps. It was associated with higher mortality rates and greater progression to end-stage chronic disease. In patients with a functioning graft, no impact on the renal function was observed after two years of follow-up, regardless of developing AKI or not.