Department of Medicine, New York City Health + Hospitals/Lincoln, Bronx, NY.
Medicine (Baltimore). 2022 Mar 18;101(11). doi: 10.1097/MD.0000000000028995.
This study aimed to characterize survivors of Coronavirus disease 2019 (COVID-19) infection and acute kidney injury (AKI) that recover their renal function or progress to acute kidney disease (AKD) on discharge; and determine factors associated with progression to AKD during hospital stay.One thousand seventy four patients with COVID-19 infection were followed up until discharge/death. The incidence of AKI was 59.7%. Two hundred and sixty-six patients were discharged alive and included in the analysis, 71.8% had renal recovery (RR) while 28.2% were discharged with AKD. The AKD subset has higher rate of chronic kidney disease (CKD) ≥3 (33.4% vs 14.1%, P = .001), congestive heart failure (18.7% vs 5.8%, P = .001), use of non-invasive mechanical ventilation (10.7% vs 3.7%, P = .026) and vasopressors (25.3% vs 12.0%, P = .007). Of 19 patients in the AKI survivor cohort who received renal replacement therapy, 1 had RR while 18 progressed to AKD on discharge. Predictors to progression to AKD were CKD ≥3 (Odds Ratio [OR]: 3.23, 95% confidence interval [CI] 1.59-6.56, P = .001), congestive heart failure (OR: 4.59, 95% CI 1.76-11.78, P = .002), AKI on admission (OR: 2.71, 95% CI, 1.14-6.46, P = .025), and ongoing diarrhea (OR: 3.19, 95% CI, 1.02-9.96, P = .025).This study demonstrates a higher proportion of RR among survivors of COVID-19 infection in our minority predominant cohort. Early identification and appropriate management of patients at-risk to progress to AKD could improve outcomes, reduce long term sequalae of CKD/end stage renal disease, and have a major impact on health outcome and financial strain on healthcare system.
这项研究旨在描述 2019 冠状病毒病（COVID-19）感染后幸存者的特征，这些幸存者在出院时肾功能恢复或进展为急性肾脏病（AKD）；并确定住院期间进展为 AKD 的相关因素。对 1074 例 COVID-19 感染患者进行了随访，直至出院/死亡。急性肾损伤（AKI）的发生率为 59.7%。266 例存活出院的患者被纳入分析，71.8%的患者肾功能恢复（RR），而 28.2%的患者出院时患有 AKD。AKD 亚组的慢性肾脏病（CKD）≥3 的发生率更高（33.4%比 14.1%，P =.001），充血性心力衰竭（18.7%比 5.8%，P =.001），使用无创机械通气（10.7%比 3.7%，P =.026）和血管加压药（25.3%比 12.0%，P =.007）的比例更高。在 AKI 幸存者队列中接受肾脏替代治疗的 19 名患者中，1 名患者 RR，18 名患者出院时进展为 AKD。进展为 AKD 的预测因素包括 CKD≥3（优势比[OR]：3.23，95%置信区间[CI] 1.59-6.56，P =.001），充血性心力衰竭（OR：4.59，95%CI 1.76-11.78，P =.002），入院时 AKI（OR：2.71，95%CI，1.14-6.46，P =.025）和持续腹泻（OR：3.19，95%CI，1.02-9.96，P =.025）。本研究表明，在以少数族裔为主的队列中，COVID-19 感染幸存者中 RR 的比例较高。早期识别和适当管理有进展为 AKD 风险的患者，可以改善结局，减少 CKD/终末期肾病的长期后果，并对健康结局和医疗保健系统的经济压力产生重大影响。
