Division of Nephrology, Department of Medicine, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI.
School of Medicine, Wayne State University, Detroit, MI.
Transplantation. 2021 Jan 1;105(1):201-205. doi: 10.1097/TP.0000000000003498.
Renal involvement in severe or critical acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is frequent. Acute kidney injury (AKI) in African American (AA) kidney transplant recipients (KTRs) with COVID-19 is not well described. We report our experience with a predominantly AA cohort (79%) of KTRs with COVID-19 infections in the Detroit Metropolitan area.
In this retrospective, single-center study, we identified 39 KTRs who tested positive for SARS-CoV-2 between March 16 and April 25, 2020. Data from electronic medical records were retrieved and compared between KTRs without AKI and KTRs with AKI.
One patient was excluded due to delayed graft function. Final analysis of AKI in KTRs with proven COVID-19 was done on 38 patients of which 30 were AA (79%). AKI occurred in 71.1% of COVID-19 KTRs (n = 27), of whom 6 (22.2%) patients required HD. The incidence of AKI in our cohort was 71% (27/38). AKI rate among AA was 76.7% versus 50% in non-AA cohort (P = 0.195). In a univariate logistic regression analysis, AA race was not significantly associated with AKI odds ratio (3.4; CI, 0.68-17.4; P = 0.14). After risk adjustment by race, patients with diabetes showed a significantly higher risk of AKI (adjusted odds ratio, 19.85; CI, 1.65-58.66; P = 0.012). KTRs with AKI had more preexisting renin angiotensin aldosterone system inhibitor use than KTRs without AKI (P = 0.03).
KTRs infected with SARS-CoV-2 have a high incidence of AKI, with associated increased morbidity and mortality. Although no racial differences in mortality were noted in our KTRs with AKI, we await data from registries to help elucidate this difference.
严重或危急的急性严重呼吸综合征冠状病毒 2（SARS-CoV-2）感染常伴有肾脏受累。非洲裔美国人（AA）肾移植受者（KTR）COVID-19 相关的急性肾损伤（AKI）并不常见。我们报告了在底特律大都市区接受 COVID-19 感染的以 AA 为主（79%）的 KTR 队列的经验。
在这项回顾性、单中心研究中，我们从 2020 年 3 月 16 日至 4 月 25 日期间的电子病历中确定了 39 例 SARS-CoV-2 检测呈阳性的 KTR。比较了 AKI 组和无 AKI 组 KTR 的临床数据。
1 例患者因延迟移植物功能而被排除。对确诊 COVID-19 的 KTR 进行了最终的 AKI 分析，共 38 例患者，其中 30 例为 AA（79%）。COVID-19 KTR 中 AKI 发生率为 71.1%（27/38），其中 6 例（22.2%）患者需要血液透析。我们队列中的 AKI 发生率为 71%（27/38）。AA 中的 AKI 发生率为 76.7%，而非 AA 组为 50%（P=0.195）。在单因素逻辑回归分析中，AA 种族与 AKI 比值比（3.4；95%CI，0.68-17.4；P=0.14）无显著相关性。经种族风险调整后，糖尿病患者 AKI 风险显著升高（调整比值比，19.85；95%CI，1.65-58.66；P=0.012）。与无 AKI 的 KTR 相比，AKI 的 KTR 更常使用肾素-血管紧张素-醛固酮系统抑制剂（P=0.03）。
SARS-CoV-2 感染的 KTR 发生 AKI 的发生率很高，与发病率和死亡率增加相关。虽然我们的 AKI KTR 中没有观察到种族间死亡率的差异，但我们仍在等待登记处的数据来帮助阐明这一差异。
