EClinicalMedicine (Jan 2023)

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

  • Byorn W.L. Tan,
  • Bryce W.Q. Tan,
  • Amelia L.M. Tan,
  • Emily R. Schriver,
  • Alba Gutiérrez-Sacristán,
  • Priyam Das,
  • William Yuan,
  • Meghan R. Hutch,
  • Noelia García 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 Zöller,
  • 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,
  • James R. Aaron,
  • Giuseppe Agapito,
  • Adem Albayrak,
  • Giuseppe Albi,
  • Mario Alessiani,
  • Anna Alloni,
  • Danilo F. Amendola,
  • François Angoulvant,
  • Li L.L.J. Anthony,
  • Bruce J. Aronow,
  • Fatima Ashraf,
  • Andrew Atz,
  • Paul Avillach,
  • Vidul Ayakulangara Panickan,
  • Paula S. Azevedo,
  • James Balshi,
  • Ashley Batugo,
  • Brett K. Beaulieu-Jones,
  • Brendin R. Beaulieu-Jones,
  • Douglas S. Bell,
  • Antonio Bellasi,
  • Riccardo Bellazzi,
  • Vincent Benoit,
  • Michele Beraghi,
  • José Luis Bernal-Sobrino,
  • Mélodie Bernaux,
  • Romain Bey,
  • Surbhi Bhatnagar,
  • Alvar Blanco-Martínez,
  • Martin Boeker,
  • Clara-Lea Bonzel,
  • John Booth,
  • Silvano Bosari,
  • Florence T. Bourgeois,
  • Robert L. Bradford,
  • Gabriel A. Brat,
  • Stéphane Bréant,
  • Nicholas W. Brown,
  • Raffaele Bruno,
  • William A. Bryant,
  • Mauro Bucalo,
  • Emily Bucholz,
  • Anita Burgun,
  • Tianxi Cai,
  • Mario Cannataro,
  • Aldo Carmona,
  • Anna Maria Cattelan,
  • Charlotte Caucheteux,
  • Julien Champ,
  • Jin Chen,
  • Krista Y. Chen,
  • Luca Chiovato,
  • Lorenzo Chiudinelli,
  • Kelly Cho,
  • James J. Cimino,
  • Tiago K. Colicchio,
  • Sylvie Cormont,
  • Sébastien Cossin,
  • Jean B. Craig,
  • Juan Luis Cruz-Bermúdez,
  • Jaime Cruz-Rojo,
  • Arianna Dagliati,
  • Mohamad Daniar,
  • Christel Daniel,
  • Priyam Das,
  • Batsal Devkota,
  • Audrey Dionne,
  • Rui Duan,
  • Julien Dubiel,
  • Scott L. DuVall,
  • Loic Esteve,
  • Hossein Estiri,
  • Shirley Fan,
  • Robert W. Follett,
  • Thomas Ganslandt,
  • Noelia García-Barrio,
  • Lana X. Garmire,
  • Nils Gehlenborg,
  • Emily J. Getzen,
  • Alon Geva,
  • Tomás González González,
  • Tobias Gradinger,
  • Alexandre Gramfort,
  • Romain Griffier,
  • Nicolas Griffon,
  • Olivier Grisel,
  • Alba Gutiérrez-Sacristán,
  • Pietro H. Guzzi,
  • Larry Han,
  • David A. Hanauer,
  • Christian Haverkamp,
  • Derek Y. Hazard,
  • Bing He,
  • Darren W. Henderson,
  • Martin Hilka,
  • Yuk-Lam Ho,
  • John H. Holmes,
  • Jacqueline P. Honerlaw,
  • Chuan Hong,
  • Kenneth M. Huling,
  • Meghan R. Hutch,
  • Richard W. Issitt,
  • Anne Sophie Jannot,
  • Vianney Jouhet,
  • Ramakanth Kavuluru,
  • Mark S. Keller,
  • Chris J. Kennedy,
  • Kate F. Kernan,
  • Daniel A. Key,
  • Katie Kirchoff,
  • Jeffrey G. Klann,
  • Isaac S. Kohane,
  • Ian D. Krantz,
  • Detlef Kraska,
  • Ashok K. Krishnamurthy,
  • Sehi L'Yi,
  • Trang T. Le,
  • Judith Leblanc,
  • Guillaume Lemaitre,
  • Leslie Lenert,
  • Damien Leprovost,
  • Molei Liu,
  • Ne Hooi Will Loh,
  • Qi Long,
  • Sara Lozano-Zahonero,
  • Yuan Luo,
  • Kristine E. Lynch,
  • Sadiqa Mahmood,
  • Sarah E. Maidlow,
  • Adeline Makoudjou,
  • Simran Makwana,
  • Alberto Malovini,
  • Kenneth D. Mandl,
  • Chengsheng Mao,
  • Anupama Maram,
  • Monika Maripuri,
  • Patricia Martel,
  • Marcelo R. Martins,
  • Jayson S. Marwaha,
  • Aaron J. Masino,
  • Maria Mazzitelli,
  • Diego R. Mazzotti,
  • Arthur Mensch,
  • Marianna Milano,
  • Marcos F. Minicucci,
  • Bertrand Moal,
  • Taha Mohseni Ahooyi,
  • Jason H. Moore,
  • Cinta Moraleda,
  • Jeffrey S. Morris,
  • Michele Morris,
  • Karyn L. Moshal,
  • Sajad Mousavi,
  • Danielle L. Mowery,
  • Douglas A. Murad,
  • Shawn N. Murphy,
  • Thomas P. Naughton,
  • Carlos Tadeu Breda Neto,
  • Antoine Neuraz,
  • Jane Newburger,
  • Kee Yuan Ngiam,
  • Wanjiku F.M. Njoroge,
  • James B. Norman,
  • Jihad Obeid,
  • Marina P. Okoshi,
  • Karen L. Olson,
  • Gilbert S. Omenn,
  • Nina Orlova,
  • Brian D. Ostasiewski,
  • Nathan P. Palmer,
  • Nicolas Paris,
  • Lav P. Patel,
  • Miguel Pedrera-Jiménez,
  • Ashley C. Pfaff,
  • Emily R. Pfaff,
  • Danielle Pillion,
  • Sara Pizzimenti,
  • Tanu Priya,
  • Hans U. Prokosch,
  • Robson A. Prudente,
  • Andrea Prunotto,
  • Víctor Quirós-González,
  • Rachel B. Ramoni,
  • Maryna Raskin,
  • Siegbert Rieg,
  • Gustavo Roig-Domínguez,
  • Pablo Rojo,
  • Paula Rubio-Mayo,
  • Paolo Sacchi,
  • Carlos Sáez,
  • Elisa Salamanca,
  • Malarkodi Jebathilagam Samayamuthu,
  • L. Nelson Sanchez-Pinto,
  • Arnaud Sandrin,
  • Nandhini Santhanam,
  • Janaina C.C. Santos,
  • Fernando J. Sanz Vidorreta,
  • Maria Savino,
  • Emily R. Schriver,
  • Petra Schubert,
  • Juergen Schuettler,
  • Luigia Scudeller,
  • Neil J. Sebire,
  • Pablo Serrano-Balazote,
  • Patricia Serre,
  • Arnaud Serret-Larmande,
  • Mohsin Shah,
  • Zahra Shakeri Hossein Abad,
  • Domenick Silvio,
  • Piotr Sliz,
  • Jiyeon Son,
  • Charles Sonday,
  • Andrew M. South,
  • Francesca Sperotto,
  • Anastasia Spiridou,
  • Zachary H. Strasser,
  • Amelia L.M. Tan,
  • Bryce W.Q. Tan,
  • Byorn W.L. Tan,
  • Suzana E. Tanni,
  • Deanne M. Taylor,
  • Ana I. Terriza-Torres,
  • Valentina Tibollo,
  • Patric Tippmann,
  • Emma M.S. Toh,
  • Carlo Torti,
  • Enrico M. Trecarichi,
  • Andrew K. Vallejos,
  • Gael Varoquaux,
  • Margaret E. Vella,
  • Guillaume Verdy,
  • Jill-Jênn Vie,
  • Shyam Visweswaran,
  • Michele Vitacca,
  • Kavishwar B. Wagholikar,
  • Lemuel R. Waitman,
  • Xuan Wang,
  • Demian Wassermann,
  • Griffin M. Weber,
  • Martin Wolkewitz,
  • Scott Wong,
  • Zongqi Xia,
  • Xin Xiong,
  • Ye Ye,
  • Nadir Yehya,
  • William Yuan,
  • Joany M. Zachariasse,
  • Janet J. Zahner,
  • Alberto Zambelli,
  • Harrison G. Zhang,
  • Daniela Zöller,
  • Valentina Zuccaro,
  • Chiara Zucco

Journal volume & issue
Vol. 55
p. 101724

Abstract

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Summary: 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.

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