Acute kidney injury and mortality risk in older adults with COVID-19

Abstract Background Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. Methods Observational study of patients admitted to two geriatric clinics in Stockholm from March 1st to June 15th, 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (OR) for the risk of AKI and in-hospital death were obtained from logistic regression. Results Three hundred-sixteen older patients were hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. AKI occurred in 92 (29%) patients with COVID-19 vs. 159 (18%) without COVID-19. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% confidence interval [CI] 1.04–2.76), low baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) [4.19 (2.48–7.05), for eGFR 30 to < 60 mL/min, and 20.3 (9.95–41.3) for eGFR < 30 mL/min], and higher C reactive protein (CRP) (OR 1.81 (1.11–2.95) in patients with initial CRP > 10 mg/L). Compared to patients without COVID-19 and without AKI, the risk of in-hospital death was highest in patients with COVID-19 and AKI [OR 80.3, 95% CI (27.3–235.6)], followed by COVID-19 without AKI [16.3 (6.28–42.4)], and by patients without COVID-19 and with AKI [10.2 (3.66–28.2)]. Conclusions Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared to patients hospitalized for other diagnoses. COVID-19 and reduced baseline kidney function were risk factors for developing AKI. AKI and COVID-19 were associated with in-hospital death.

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MO358ACUTE KIDNEY INJURY AND MORTALITY RISK IN OLDER ADULTS WITH AND WITHOUT COVID-19: DATA FROM GEROCOVID STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Hong Xu ◽

Sara Garcia-Ptacek ◽

Martin Annetorp ◽

Annette Bruchfeld ◽

Tommy Cederholm ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Kidney Function ◽

Geriatric Patients ◽

Vital Signs ◽

Kidney Injury ◽

Adverse Outcomes ◽

Hospital Death ◽

The Difference ◽

Hospitalized Older Adults

Abstract Background and Aims Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated the risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. Method Observational study of patients admitted to two geriatric clinics in the Stockholm Region of Sweden during the first wave of the COVID-19 pandemic from March 1st to June 15th 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (ORs) for AKI were obtained from logistic regressions. The hazard ratios (HRs) for the risk of in-hospital death were calculated from Cox proportional hazard regression models. Results We analyzed 316 older patients hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. The mean age was 83±9 years, 57% were women, and mean baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) was 62±23 ml/min/1.73m2. AKI occurred in 92 (29%) of patients with COVID-19 vs. 159 (18%) without COVID-19. The severity of AKI was significantly worse in patients with COVID-19 compared with non-COVID patients. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% CI, 1.04-2.76), low baseline kidney function [4.19 (2.48-7.05), for eGFR 30 ∼ <60 ml/min/1.73m2, and 20.3 (9.95-41.3) for eGFR <30ml/min/1.73m2], and higher C-reactive protein (CRP) level (OR 1.81(1.11-2.95)). The risk of in-hospital death was highest in patients with COVID-19 and AKI [adjusted HR 23.5, 95% CI (8.75-63.0)], followed by COVID-19 without AKI [9.10 (3.52-23.6)] and by patients without COVID-19 and with AKI [6.38 (2.28-17.9)] after adjusting for patient demographics, vital signs, baseline kidney function and medications and using non-COVID patients with no AKI as reference. Conclusion Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared with patients hospitalized with other diagnoses. AKI and COVID-19 were associated with in-hospital death. Optimal management of AKI may improve the outcome of COVID-19 in geriatric patients.

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Incidence, risk factors, and adverse outcomes of acute kidney injury in very premature neonates: a single center experience

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-2012-348 ◽

2021 ◽

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Adverse Outcomes ◽

Single Center ◽

Premature Neonates ◽

Single Center Experience ◽

Incidence Risk

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Incidence, Risk Factors and Mortality Outcome in Patients with Acute Kidney Injury in COVID-19: A Single-Center Observational Study

10.1101/2020.06.24.20138230 ◽

2020 ◽

Cited By ~ 1

Author(s):

Alfano Gaetano ◽

Ferrari Annachiara ◽

Fontana Francesco ◽

Mori Giacomo ◽

Magistroni Riccardo ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cox Regression ◽

Case Fatality ◽

Kidney Injury ◽

Serum Levels ◽

University Hospital ◽

Hospital Death ◽

Cox Regression Analysis ◽

Incidence Risk

AbstractBackgroundAcute kidney injury (AKI) is a recently recognized complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate the incidence, risk factors and case-fatality rate of AKI in patients with documented COVID-19.MethodsWe reviewed the health medical records of 307 consecutive patients hospitalized for symptoms of COVID-19 at the University Hospital of Modena, Italy.ResultsAKI was diagnosed in 69 out of 307 (22.4%) patients. The stages of AKI were stage 1 in 57.9%, stage 2 in 24.6% and stage 3 in 17.3%. Hemodialysis was performed in 7.2% of the subjects. AKI patients had a mean age of 74.7±9.9 years and higher serum levels of the main marker of inflammation and organ involvement (lung, liver, hearth and liver) than non-AKI patients. AKI events were more frequent in subjects with severe lung comprise. Two peaks of AKI events coincided with in-hospital admission and death of the patients. Kidney injury was associate with a higher rate of urinary abnormalities including proteinuria (0.448±0.85 vs 0.18±0.29; P=<0.0001) and hematuria (P=0.032) compared to non-AKI patients. At the end of follow-up, 65.2% of the patients did not recover their renal function after AKI. Risk factors for kidney injury were age, male sex, CKD and non-renal SOFA. Adjusted Cox regression analysis revealed that AKI was independently associated with in-hospital death (hazard ratio [HR]=3.74; CI 95%, 1.34-10.46) compared to non-AKI patients. Groups of patients with AKI stage 2-3 and failure to recover kidney function were associated with the highest risk of in-hospital mortality. Lastly, long-hospitalization was positively associated with a decrease of serum creatinine, likely due to muscle depletion occurred with prolonged bed rest.ConclusionsAKI was a dire consequence of patients with COVID-19. Identification of patients at high-risk for AKI and prevention of kidney injury by avoiding dehydration and nephrotoxic agents is imperative in this vulnerable cohort of patients.

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Abstract 196: Acute Kidney Injury in Aneurysmal Subarachnoid Hemorrhage: Incidence, Risk Factors, and Outcomes

Stroke ◽

10.1161/str.47.suppl_1.196 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kavelin Rumalla ◽

Adithi Reddy ◽

Rajiv Gummadi ◽

Manoj Mittal

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Subarachnoid Hemorrhage ◽

Chronic Renal Disease ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Hospital Costs ◽

Kidney Injury ◽

Hospital Death ◽

Age Group ◽

Incidence Risk

Introduction: Acute kidney injury (AKI) increases morbidity and mortality in several acute illnesses. Here, we examine the incidence, risk factors, and in-hospital outcomes of AKI in patients hospitalized for aneurysmal subarachnoid hemorrhage (aSAH). Methods: The Nationwide Inpatient Sample was queried from 2002 and 2011 for all emergency hospitalizations (age≥18) with a primary diagnosis of aSAH and a secondary diagnosis of AKI. Patients with chronic renal disease, renal transplant, or trauma were excluded from the analysis. The effect of various patient factors on AKI incidence and its impact on length of stay (LOS), in-hospital costs, and in-hospital mortality was examined in bivariate and multivariate analyses. Results: Of 250,437 total hospitalizations for aSAH, the overall incidence of AKI was 4.0% (n=10,450) and increased from 2.1% in 2002 to 5.7% in 2011 (p<0.0001). The strongest multivariate predictors of AKI were 60-74 age group (OR: 1.43, 95% CI: 1.31-1.56), 75+ age group (OR: 1.81, 95% CI: 1.63-2.00), male gender (OR: 1.80, 95% CI: 1.69-1.87), Black race (OR: 1.45, 95% CI: 1.35-1.55), Medicaid insurance (OR: 1.29, 95% CI: 1.19-1.40), congestive heart failure (OR: 2.13, 95% CI: 1.98-2.28), liver disease (OR: 2.42, 95% CI: 2.13-2.75), fluid/electrolyte disorder (OR: 3.10, 95% CI: 2.95-3.27), and HIV (OR: 2.24, 95% CI: 1.66-3.01) (all p<0.0001). Aneurysmal coiling (OR: 0.81, 95% CI: 0.75-0.87) and clipping (OR: 0.75, 95% CI: 0.70-0.80) decreased the likelihood of suffering AKI (all p<0.0001). Cardiac arrest, septic shock, and acute lung injury were in-hospital complications that increased the odds of AKI (all p<0.0001). AKI occurrence in aSAH increased the mean LOS by 7.2 days and mean total costs by $28,813 (all p<0.0001). After adjusting for confounding factors, aSAH related AKI patients had increased likelihood of moderate to severe disability (OR: 2.03, 95% CI: 1.89-2.19, p<0.0001) and in-hospital death (OR: 2.14, 95% CI: 2.03-2.26, p<0.0001). Conclusion: The incidence of AKI in hospitalized aSAH patients has increased over the past decade and is both detrimental to hospital costs and patient prognosis. We identified patient-centered risk factors for AKI, allowing for the close surveillance of patients at the highest risk for AKI.

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Risk factors and prognosis for COVID-19-induced acute kidney injury: a meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-042573 ◽

2020 ◽

Vol 10 (11) ◽

pp. e042573

Author(s):

Lirong Lin ◽

Xiang Wang ◽

Jiangwen Ren ◽

Yan Sun ◽

Rongjie Yu ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Evaluation Criteria ◽

Kidney Injury ◽

Hospital Death ◽

Risk Of Death ◽

Study Selection ◽

Incidence Risk ◽

Independent Risk Factors

ObjectiveTo analyse the incidence, risk factors and impact of acute kidney injury (AKI) on the prognosis of patients with COVID-19.DesignMeta-analysis.Data sourcesPubMed, Embase, CNKI and MedRxiv of Systematic Reviews from 1 January 2020 to 15 May 2020.Study selectionStudies examining the following demographics and outcomes were included: patients’ age; sex; incidence of and risk factors for AKI and their impact on prognosis; COVID-19 disease type and incidence of continuous renal replacement therapy (CRRT) administration during COVID-19 infection.ResultsA total of 79 research articles, including 49 692 patients with COVID-19, met the systemic evaluation criteria. The mortality rate and incidence of AKI in patients with COVID-19 in China were significantly lower than those in patients with COVID-19 outside China. A significantly higher proportion of patients with COVID-19 from North America were aged ≥65 years and also developed AKI. European patients with COVID-19 had significantly higher mortality and a higher CRRT rate than patients from other regions. Further analysis of the risk factors for COVID-19 combined with AKI showed that age ≥60 years and severe COVID-19 were independent risk factors for AKI, with an OR of 3.53, 95% CI (2.92–4.25) and an OR of 6.07, 95% CI (2.53–14.58), respectively. The CRRT rate in patients with severe COVID-19 was significantly higher than in patients with non-severe COVID-19, with an OR of 6.60, 95% CI (2.83–15.39). The risk of death in patients with COVID-19 and AKI was significantly increased, with an OR of 11.05, 95% CI (9.13–13.36).ConclusionAKI was a common and serious complication of COVID-19. Older age and having severe COVID-19 were independent risk factors for AKI. The risk of in-hospital death was significantly increased in patients with COVID-19 complicated by AKI.

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Is acute kidney injury age-dependent in older adults: an observational study in two centers from North China

BMC Geriatrics ◽

10.1186/s12877-020-01906-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Libin Xu ◽

◽

Yanhua Wu ◽

Yuanhan Chen ◽

Ruiying Li ◽

...

Keyword(s):

Older Adults ◽

Acute Kidney Injury ◽

Hospital Admissions ◽

Multivariable Analysis ◽

Kidney Injury ◽

Adverse Outcomes ◽

Charlson Comorbidity Index Score ◽

Hospital Death ◽

Dependent Manner ◽

Age Dependent

Abstract Background Although aging increases susceptibility to acute kidney injury (AKI), whether the AKI risk and the association between AKI and adverse outcomes are age-dependent remain unclear in older adults. The current study aimed to identify whether AKI risk was age-dependent in older adults and to investigate whether the association between AKI and mortality increased with increasing age. Methods Medical records from 47,012 adult hospital admissions, including 30,194 older adults aged 60 or older, in two tertiary general hospitals were studied retrospectively. AKI was identified based on changes in blood creatinine levels according to the Kidney Disease: Improving Global Outcomes criteria. Results Among the total population and 30,194 older adult patients, the raw incidences of AKI were 8.2 and 8.3%, respectively. The curve of the age-grouped AKI incidence was “U-shaped”, which revealed a positive relationship between the AKI incidence and age among the older adults aged 75 years or older. This trend of the age-AKI relationship was supported by further multivariable analysis. After adjusting for the Charlson Comorbidity Index score, the AKI was associated with in-hospital mortality; however, the associations did not increase with increasing age. Conclusion The AKI risk does not increase with age in older adults, except for those aged 75 and above. The association between AKI and in-hospital death did not increase in an age-dependent manner in older adults. Trial registration This study was retrospectively registered at clinicaltrials.gov (NCT03054142) on February 13, 2017.

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Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: A prospective multicenter study*

Critical Care Medicine ◽

10.1097/ccm.0b013e31821201d3 ◽

2011 ◽

Vol 39 (6) ◽

pp. 1493-1499 ◽

Cited By ~ 234

Author(s):

Simon Li ◽

Catherine D. Krawczeski ◽

Michael Zappitelli ◽

Prasad Devarajan ◽

Heather Thiessen-Philbrook ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Multicenter Study ◽

Kidney Injury ◽

Pediatric Cardiac Surgery ◽

Prospective Multicenter Study ◽

Incidence Risk

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Abstract TP161: Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes

Stroke ◽

10.1161/str.47.suppl_1.tp161 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kavelin Rumalla ◽

Adithi Y Reddy ◽

Vijay Letchuman ◽

Paul A Berger ◽

Manoj K Mittal

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Bowel Obstruction ◽

Kidney Injury ◽

Hospital Death ◽

Stroke Incidence ◽

Black Race ◽

Electrolyte Disorder ◽

Incidence Risk

Introduction: The prognosis of patients suffering acute ischemic stroke (AIS) is worsened by medical complications that occur during subsequent hospitalization. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS have not been previously reported. Methods: We employed the Nationwide Inpatient Sample from 2002 to 2011 to identify all patients admitted with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariate logistic regression was utilized to analyze predictors of GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes. Results: We identified 16,987 patients with GIBO (425 per 100,000) among 3,988,667 AIS hospitalizations and 4.2% of patients of these patients underwent repair surgery for intestinal obstruction. Multivariate predictors of GIBO included: age 55-64 (OR: 1.52, 95% CI: 1.40-1.64), age 65-74 (OR: 1.69, 95% CI: 1.56-1.84), age 75+ (OR: 1.97, 95% CI: 1.81-2.13), black race (OR: 1.42, 95% CI: 1.36-1.49), coagulopathy (OR: 1.39, 95% CI: 1.29-1.50), cancer (OR: 1.59, 95% CI: 1.44-1.75), blood loss anemia (OR: 2.51, 95% CI: 2.22-2.84), fluid/electrolyte disorder (OR: 2.91, 95% CI: 2.81-3.02), weight loss (OR: 3.08, 95% CI: 2.93-3.25), and thrombolytic therapy (OR: 1.30, 95% CI: 1.20-1.42) (all p<0.0001). Patients with GIBO had a greater likelihood of suffering intubation (OR: 1.79, 95% CI: 1.70-1.90), deep vein thrombosis (OR: 1.35, 95% CI: 1.25-1.46), pulmonary embolism (OR: 1.84, 95% CI: 1.53-2.21), sepsis (OR: 2.39, 95% CI: 2.22-2.56), acute kidney injury (OR: 1.85, 95% CI: 1.76-1.95), gastrointestinal hemorrhage (OR: 2.82, 95% CI: 2.63-3.03), and blood transfusions (OR: 2.02, 95% CI: 1.90-2.15) (all p<0.0001). In adjusted analyses, AIS patients with GIBO were 284% and 39% more likely to face moderate to severe disability and in-hospital death, respectively (p<0.0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (p<0.0001). Conclusion: Advanced age, black race, and several pre-existing comorbidities increase the likelihood of post-AIS GIBO, which is an independent predictor of in-hospital complications, disability, and mortality.

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