COVID-19 AND KIDNEY HEALTH: ANALYZING THE IMPACT AND OUTCOMES OF ACUTE KIDNEY INJURY IN COVID-19 PATIENTS IN A PERUVIAN HOSPITAL.

The emergence of COVID-19 has presented multifaceted challenges for healthcare systems globally. Among these, the incidence of acute kidney injury (AKI) in patients affected by the virus has been increasingly recognized as a factor significantly influencing morbidity and mortality rates. This retrospective cohort study aims to elucidate the prevalence, characteristics, and outcomes of AKI among hospitalized patients with COVID-19. The association of AKI with elevated mortality rates underscores the need for vigilant monitoring and strategic interventions to improve patient outcomes in this vulnerable cohort.

Data collected from electronic records of 318 patients with COVID-19 AND AKI in a Peruvian hospital during the first and second wave of the pandemic are analyzed. The study evaluates the efficacy of the International Consortium for the Clinical Characterization of Coronavirus (ISARIC4C) score as a predictive indicator of deterioration in these patients. In addition, it evaluates the survival rate after hospital discharge after one year of follow-up, including leading causes of death.

In a retrospective cohort analysis, we evaluated data from 6,480 patients diagnosed with SARS-Cov-2 pneumonia at Hospital Nacional Alberto Sabogal Sologuren during the first two waves of the pandemic (March 16 to August 2020 and December 2020 to June 2021). Of these, 3,076 patients (47.46%) succumbed to the disease. Acute Kidney Injury (AKI) was identified in 318 cases (4.9%). The average age of patients with AKI was 67.34 years, ranging from 29 to 97, with males comprising 76.73% (244 patients). Hypertension was present in 56.92% (181 patients), diabetes in 34.9% (111 patients), cardiovascular diseases in 8.55% (27 patients), obesity in 25.5% (81 patients), chronic kidney disease and respiratory illnesses in 39.6% (126 patients), and 8.8% (28 patients), respectively.

Table Nº1: Creatinine levels

Diagnostic testing revealed that 50% of patients underwent IgG/IgM serological immunoassays, with 38.7% (123) testing positive. PCR-RT was performed on 23.2% of patients, with a positivity rate of 16% (51), and antigen tests were done on 44.3% of patients, yielding a 35.2% (112) positivity rate.

Upon admission, the average oxygen saturation was 85.58% (range 50-98%), and the median hospital stay was 14.62 days (range 1-87 days). Average creatinine levels were 2.4mg/dl (range 0.35-13.47) at admission, rising to 6.45mg/dl (range 2.7-14.05) at the start of renal replacement therapy. Creatinine levels were 1.6mg/dl (range 0.41-7.66) at discharge, and 2.9mg/dl (range 0.24-11.7) at death.

AKI was present at the start of hospitalization in 77% (245) of patients, with 56.6% (180) of them dying. The risk of death for these patients was significantly higher (OR 5.1, p=0.023) compared to those without initial AKI diagnosis. Among the AKI cases, 16.7% (53) were classified as KDIGO 1, with 11.9% (38) mortality (OR 0.78, p=0.37), 25.5% (81) as KDIGO 2 with a mortality risk (OR=3.1, p=0.74), and 57.9% (184) as KDIGO 3, which had a very high mortality risk (OR=5.04, p=0.025). Only 18.6% (59) of patients with KDIGO 3 AKI received renal replacement therapy, and of these, 76.3% (45) died. The average number of dialysis sessions was 4.12 (range 1-12).

Overall, the mortality rate for COVID-19 patients with AKI was 76.7% (244 patients), with an average age of 67.88 years (range 29-97). Renal function was regained in 31.4% (100) of AKI patients, half of whom died despite the recovery.

Critical care was provided to 23.9% (76 patients), with a high fatality rate of 85.5% (65 patients). The average age of patients admitted to the ICU was 56.97 years (range 29-84), compared to 70.59 years (range 33-97) for those who did not receive such care.

The 20-day survival rate for AKI patients was 30%, with intermediate ISARIC4C scores indicating better survival than those with high or very high scores (p=0.000). For patients who recovered from COVID-19 and were discharged (74 patients), the one-year survival rate was 85.1%, with respiratory failure being the primary cause of death after one year.

Table Nº2:Demographics and clinical characteristics

AKI associated with COVID-19 leads to a higher mortality rate, which is markedly elevated even at the initial stages of kidney injury, indicating the need for heightened critical care and resource allocation for affected individuals.

The ISARIC 4C Mortality Score has proven to be an effective and reliable tool for predicting the mortality risk of patients at the time of hospital admission for COVID-19.