Critically ill intubated Covid-19 patients with acute kidney injury (AKI) are at high risk of developing chronic kidney disease (CKD), suggests a new study presented at the recently concluded National Kidney Foundation Spring Clinical Meetings held in Boston, USA.

This retrospective case control study included 125 intubated patients with pneumonia from January 1, 2020 to December 31, 2020. Of these 56 had confirmed COVID-19 pneumonia and 69 had bacterial pneumonia. Logistic regression analysis and Cox proportional hazard ratio were the statistical methods used to evaluate the probability and the risk of CKD at 90 days in intubated COVID-19 patients after incident AKI during hospitalization. Serum creatinine levels were measured at baseline, during the first incident AKI, at the time of discharge and at 90 days.

A total of 56 Covid pneumonia patients developed AKI during hospitalization, while 69 patients with bacterial pneumonia had AKI. However, renal recovery occurred in 68% Covid-19 pneumonia patients with AKI vs 84% bacterial pneumonia patients with AKI.

Analysis of renal outcomes of AKI patients showed that the intubated Covid-19 patients with new onset AKI during hospitalization were 2.6 times more likely to progress to CKD within 90 days with a hazard ratio of 2.48 (148% higher risk). Thirty percent of Covid patients developed CKD vs 16% in patients with bacterial pneumonia.

More Covid-19 patients needed emergent hemodialysis during hospital stay (20%) compared to bacterial pneumonia patients (7%) corresponding to higher incidence of post-discharge dialysis in Covid patients compared to bacterial pneumonia patients; 18% vs 3%, respectively.

The average peak creatinine level in Covid-19 pneumonia patients was 2.16 mg/dL in comparison to a peak of 2.03 mg/dL in bacterial pneumonia patients. However, at 90 days, the average levels in both groups were 0.90 mg/dL.

These observations reiterate the high risk of AKI in critically ill intubated patients with pneumonia but the risk was higher and the prognosis was worse in patients with Covid-19 pneumonia than in bacterial pneumonia patients regardless of comorbidities, duration of mechanical ventilation or highest AKI stage. These findings highlight the need to closely monitor renal function as inpatients and particularly after discharge, as outpatients, to check for disease progression and timely intervention.

Reference

1. Edding S, et al. Renal function dynamics among mechanically ventilated patients with acute kidney injury (AKI) and COVID-19 pneumonia. NKF 2022; Poster #5. https://cme.kidney.org/spa/courses/resource/2022-spring-clinical-meetings/event/home/posters/abstracts?abstractId=8