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Pitre T, Dong A(HT, Jones A, Kapralik J, Cui S, Mah J, Helmeczi W, Su J, Patel V, Zia Z, Mallender M, Tang X, Webb C, Patro N, Junek M, Duong M, Ho T, Beauchamp MK, Costa AP, Kruisselbrink R, Tsang JL, Walsh M. Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211027759. [PMID: 34290876 PMCID: PMC8278450 DOI: 10.1177/20543581211027759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. OBJECTIVE To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. DESIGN Retrospective cohort study from a registry of patients with COVID-19. SETTING Three community and 3 academic hospitals. PATIENTS A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. MEASUREMENTS Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. METHODS We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. RESULTS Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). LIMITATIONS Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. CONCLUSIONS Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. TRIAL REGISTRATION The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.
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Affiliation(s)
- Tyler Pitre
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Aaron Jones
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jessica Kapralik
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Sonya Cui
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jasmine Mah
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Wryan Helmeczi
- Department of Internal Medicine, University of Ottawa, ON, Canada
| | - Johnny Su
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Vivek Patel
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Zaka Zia
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Michael Mallender
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Xinxin Tang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cooper Webb
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nivedh Patro
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mats Junek
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - MyLinh Duong
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Terence Ho
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Marla K. Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Andrew P. Costa
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Rebecca Kruisselbrink
- Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jennifer L.Y. Tsang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Departmet of Medicine, Niagara Health, St. Catharines, ON, Canada
| | - Michael Walsh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, ON, Canada
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