Outcome of acute kidney injury in Covid 19 patients admitted in SIUT hospital Karachi- a retrospective study from march 2020 till march 2021

Abstract

Objective: To observe the outcome of Corona-virus disease-2019 patients who with acute kidney injury.

Method: The retrospective cohort study was conducted from January 2022 to June 2023 at the Sindh Institute of Urology and Transplantation, Karachi, and comprised data of patients aged at least 18 years who tested positive for corona-virus disease-2019 and either had acute kidney injury at the time of admission or developed it during hospital stay between March 2020 and March 2021. The stage of acute kidney injury was determined using the peak serum creatinine level after acute kidney injury detection. Demographics, previous co morbid conditions, clinical features, laboratory investigations at the time of corona-virus disease-2019 positive and during admission were obtained from the hospital record. Data was recorded about severity of acute kidney injury, requirement of dialysis and outcome in terms of full recovery, partial recovery, non-recovery and death. Data was analyzed using SPSS 22.

Results: Of the 131 patients, 63(50.4%) died; 47(74.6) males and 16(74.6) females with median age 57 years (inter-quartile range: 50-69 years). There were 68(49.6%) survivors; 46(67.6%) males and 22(32.4%) females with median age 55 years (inter-quartile range: 41-68 years). Baseline demographic and clinical profile was similar between the groups (p>0.05) except for higher smoking prevalence among the non-survivors (p=0.022). Extensive bilateral lung infiltrates were significantly associated with mortality (p<0.001). At admission, non-survivors had significantly higher urea, sodium, C-reactive protein, lactate dehydrogenase, and D-dimer levels (p<0.05). Elevated C-reactive protein >10 was strongly associated with mortality (p<0.05). Advanced acute kidney injury stage 3 was more frequent among non-survivors (p=0.005). Nearly half of the patients required kidney replacement therapy, espcially those with stage 3 acute kidney injury. Renal recovery occurred in almost 75% of survivors, but was significantly lower in advanced stages (p<0.001). Non-survivors required more intensive care, including mechanical ventilation (p<0.001) and haemodialysis (p=0.007), and were more likely to be critically ill (p<0.001). Mortality increased progressively with AKI severity.

Conclusion: Corona-virus disease-2019 patients with acute kidney injury had high mortality, particularly in advanced stages. Severe inflammation, respiratory failure and renal dysfunction were key drivers of poor outcomes.

Key Words: COVID-19, SARS-CoV-2, Acute kidney injury related to COVID-19, Haemodialysis associated with AKI in COVID-19, COVID-19-related hospital mortality.