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

The Consortium For Clinical Characterization Of COVID-19 By EHR (4CE)

doi:10.1016/j.eclinm.2022.101724

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

The Consortium For Clinical Characterization Of COVID-19 By EHR (4CE)

Research output: Contribution to journal › Article › peer-review

35 Scopus citations

Abstract

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.

Original language	English (US)
Article number	101724
Journal	EClinicalMedicine
Volume	55
DOIs	https://doi.org/10.1016/j.eclinm.2022.101724
State	Published - Jan 1 2023

Funding

BWQT is supported by the National Medical Research Council Research Training Fellowship (MOH-000195-00). WY is supported by the National Institutes of Health (NIH) (T32HD040128). MH is supported by the NIH National Library of Medicine (NLM) (5T32LM012203-05). NGB is supported by Carlos III Health Institute (PI18/00981). NA is supported by the NIH National Center for Advancing Translational Science (NCATS) (CTSA Award #UL1TR002366). LPP is supported by the NIH NCATS (CTSA Award #UL1TR002366). AMS is supported by the NIH National Heart Lung and Blood Institute (NHLBI) (K23HL148394, L40HL148910) and NCATS (UL1TR001420). SV is supported by the NIH NLM (R01LM012095) and NCATS (UL1TR001857). DAH is supported by NIH NCATS (UL1TR002240). ML is supported by the NIH NCATS (CTSA Award #UL1TR002366) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (R01DK116986). DLM is supported by the NIH NCATS CSTA award (UL1-TR001878). YL is supported by NIH NLM (1R01LM013337). RB is supported by European Union Periscope Project (101016233). ZX is supported by the NIH National Institute of Neurological Disorders and Stroke (NINDS) (R01NS098023). GMW is supported by NIH NCATS (UL1TR002541 and UL1TR000005), NIH NLM (R01LM013345) and NIH NHGRI (3U01HG008685-05S2). GSO is supported by the NIH (P30ES017885, U24CA210967). JHH is supported by NIH/NCATS Institutional Clinical and Translational Science Award (UL1-TR001878).

Keywords

Acute kidney injury
COVID-19
Chronic kidney disease
Electronic health records
SARS-CoV-2

ASJC Scopus subject areas

General Medicine

Access to Document

10.1016/j.eclinm.2022.101724

Cite this

@article{e3dd639dbcb04879b000784a4557ba41,

title = "Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: An international multi-centre observational cohort study",

abstract = "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.",

keywords = "Acute kidney injury, COVID-19, Chronic kidney disease, Electronic health records, SARS-CoV-2",

author = "{The Consortium For Clinical Characterization Of COVID-19 By EHR (4CE)} and Tan, {Byorn W.L.} and Tan, {Bryce W.Q.} and Tan, {Amelia L.M.} and Schriver, {Emily R.} and Alba Guti{\'e}rrez-Sacrist{\'a}n and Priyam Das and William Yuan and Hutch, {Meghan R.} and {Garc{\'i}a Barrio}, Noelia and {Pedrera Jimenez}, Miguel and Noor Abu-el-rub and Michele Morris and Bertrand Moal and Guillaume Verdy and Kelly Cho and Ho, {Yuk Lam} and Patel, {Lav P.} and Arianna Dagliati and Antoine Neuraz and Klann, {Jeffrey G.} and South, {Andrew M.} and Shyam Visweswaran and Hanauer, {David A.} and Maidlow, {Sarah E.} and Mei Liu and Mowery, {Danielle L.} and Ashley Batugo and Adeline Makoudjou and Patric Tippmann and Daniela Z{\"o}ller and Brat, {Gabriel A.} and Yuan Luo and Paul Avillach and Riccardo Bellazzi and Luca Chiovato and Alberto Malovini and Valentina Tibollo and Samayamuthu, {Malarkodi Jebathilagam} and Pablo Serrano-Balazote and Zongqi Xia and Loh, {Ne Hooi Will} and Lorenzo Chiudinelli and Bonzel, {Clara Lea} and Chuan Hong and Zhang, {Harrison G.} and Weber, {Griffin M.} and Kohane, {Isaac S.} and Tianxi Cai and Chengsheng Mao and Sanchez-Pinto, {L. Nelson}",

note = "Publisher Copyright: {\textcopyright} 2022",

year = "2023",

month = jan,

day = "1",

doi = "10.1016/j.eclinm.2022.101724",

language = "English (US)",

volume = "55",

journal = "EClinicalMedicine",

issn = "2589-5370",

publisher = "Lancet Publishing Group",

}

TY - JOUR

T1 - Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury

T2 - An international multi-centre observational cohort study

AU - The Consortium For Clinical Characterization Of COVID-19 By EHR (4CE)

AU - Tan, Byorn W.L.

AU - Tan, Bryce W.Q.

AU - Tan, Amelia L.M.

AU - Schriver, Emily R.

AU - Gutiérrez-Sacristán, Alba

AU - Das, Priyam

AU - Yuan, William

AU - Hutch, Meghan R.

AU - García Barrio, Noelia

AU - Pedrera Jimenez, Miguel

AU - Abu-el-rub, Noor

AU - Morris, Michele

AU - Moal, Bertrand

AU - Verdy, Guillaume

AU - Cho, Kelly

AU - Ho, Yuk Lam

AU - Patel, Lav P.

AU - Dagliati, Arianna

AU - Neuraz, Antoine

AU - Klann, Jeffrey G.

AU - South, Andrew M.

AU - Visweswaran, Shyam

AU - Hanauer, David A.

AU - Maidlow, Sarah E.

AU - Liu, Mei

AU - Mowery, Danielle L.

AU - Batugo, Ashley

AU - Makoudjou, Adeline

AU - Tippmann, Patric

AU - Zöller, Daniela

AU - Brat, Gabriel A.

AU - Luo, Yuan

AU - Avillach, Paul

AU - Bellazzi, Riccardo

AU - Chiovato, Luca

AU - Malovini, Alberto

AU - Tibollo, Valentina

AU - Samayamuthu, Malarkodi Jebathilagam

AU - Serrano-Balazote, Pablo

AU - Xia, Zongqi

AU - Loh, Ne Hooi Will

AU - Chiudinelli, Lorenzo

AU - Bonzel, Clara Lea

AU - Hong, Chuan

AU - Zhang, Harrison G.

AU - Weber, Griffin M.

AU - Kohane, Isaac S.

AU - Cai, Tianxi

AU - Mao, Chengsheng

AU - Sanchez-Pinto, L. Nelson

PY - 2023/1/1

Y1 - 2023/1/1

N2 - 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.

AB - 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.

KW - Acute kidney injury

KW - COVID-19

KW - Chronic kidney disease

KW - Electronic health records

KW - SARS-CoV-2

UR - http://www.scopus.com/inward/record.url?scp=85141512399&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85141512399&partnerID=8YFLogxK

U2 - 10.1016/j.eclinm.2022.101724

DO - 10.1016/j.eclinm.2022.101724

M3 - Article

C2 - 36381999

AN - SCOPUS:85141512399

SN - 2589-5370

VL - 55

JO - EClinicalMedicine

JF - EClinicalMedicine

M1 - 101724

ER -

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this