Nobakht Niloofar, Jang Charley, Grogan Tristan, Fahim Peter, Kurtz Ira, Schaenman Joanna, Wilson James, Kamgar Mohammad
Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, LA.
Department of Medicine Statistics Core, Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, LA.
Kidney Med. 2025 Jun 18;7(7):101020. doi: 10.1016/j.xkme.2025.101020. eCollection 2025 Jul.
RATIONALE & OBJECTIVE: Acute kidney injury (AKI) is a common complication in patients with Coronavirus disease-2019 (COVID-19) infections, with rates as high as 32% to 46%, and it has been associated with poor outcomes. However, the long-term renal and survival outcomes among hospitalized patients with COVID-19 and AKI are not fully understood.
A single-center cohort study.
SETTING & PARTICIPANTS: Total of 972 adult patients admitted with COVID-19 infection and AKI at a single large urban academic medical center from March 1, 2022, to March 30, 2022. Among these, 411 (42.3%) did not receive a dose of a US FDA-approved COVID-19 vaccine, and 467 (48.0%) had completed the primary vaccine series.
Patients admitted with COVID-19 infection and AKI were analyzed using vaccination status as the exposure. Additional exposures included demographics, comorbid conditions, and need for continuous renal replacement therapy (CRRT) during hospitalization.
The primary outcome was in-hospital mortality. Secondary outcomes included long-term mortality, length of hospital stay, and the need for renal replacement therapy (RRT) at discharge.
The vaccinated and unvaccinated cohorts were characterized using descriptive analyses. The cohorts were analyzed using the Kaplan-Meier method and groups were compared using the log-rank test. Multivariable cox, logistic, and linear regression models were used for mortality, RRT status at discharge, and length of stay, respectively.
Among 3,527 hospitalized patients with a COVID-19 infection, AKI occurred in 972 patients. Of the 972 patients with AKI, 411 (42.3%) did not receive a dose of a US FDA-approved COVID-19 vaccine and 467 (48.0%) had completed the primary vaccine series. Unvaccinated patients had a higher rate of requiring CRRT during their hospitalization compared with vaccinated patients (15.8% vs 10.9%, = 0.03). The CRRT during hospitalization was significantly associated with in-hospital death (adjusted HR 2.82; 95% CI, 1.88-4.25) and long-term follow-up death (adjusted HR 2.44; 95% CI, 1.73-3.42). Unvaccinated patients also had a 2.56 (95% CI, 1.52-4.30) times higher odds of being discharged on RRT when compared with those who were vaccinated. In an adjusted multivariable analysis, those who were unvaccinated had both significantly increased in-hospital mortality (adjusted HR 5.54; 95% CI, 3.36-9.13) and long-term follow-up mortality (adjusted HR 4.78; 95% CI, 3.39-6.73) when compared with those who were vaccinated.
There was a lack of data on the ventilation status and other indicators of infection severity in patients in intensive care unit who received CRRT. In addition, data on booster COVID-19 vaccinations were lacking.
Vaccinated patients with a COVID-19 infection and AKI had an increase overall survival and were less likely to remain on RRT at the time of discharge. Further studies evaluating the underlying etiologies of AKI and renal outcomes among patients admitted with COVID-19 infection in both vaccinated and unvaccinated patients is important in the development of targeted therapies and guidance on management and follow-up approaches to monitor renal recovery and model outcomes for providing chronic kidney disease care for these patients.
急性肾损伤（AKI）是2019冠状病毒病（COVID-19）感染患者的常见并发症，发生率高达32%至46%，且与不良预后相关。然而，COVID-19合并AKI的住院患者的长期肾脏和生存结局尚未完全明确。
单中心队列研究。
2022年3月1日至2022年3月30日期间，在一家大型城市学术医疗中心收治的972例COVID-19感染合并AKI的成年患者。其中，411例（42.3%）未接种一剂美国食品药品监督管理局（FDA）批准的COVID-19疫苗，467例（48.0%）已完成主要疫苗接种系列。
将接种疫苗状态作为暴露因素，对收治的COVID-19感染合并AKI患者进行分析。其他暴露因素包括人口统计学特征、合并症以及住院期间是否需要持续肾脏替代治疗（CRRT）。
主要结局指标为住院死亡率。次要结局指标包括长期死亡率、住院时间以及出院时是否需要肾脏替代治疗（RRT）。
采用描述性分析对接种疫苗组和未接种疫苗组进行特征描述。采用Kaplan-Meier法进行队列分析，使用对数秩检验比较组间差异。分别使用多变量Cox回归、逻辑回归和线性回归模型分析死亡率、出院时的RRT状态以及住院时间。
在3527例住院的COVID-19感染患者中，972例发生了AKI。在这972例AKI患者中，411例（42.3%）未接种一剂美国FDA批准的COVID-19疫苗，467例（48.0%）已完成主要疫苗接种系列。与接种疫苗的患者相比，未接种疫苗的患者在住院期间需要CRRT的比例更高（15.8%对10.9%，P = 0.03）。住院期间的CRRT与住院死亡（调整后HR 2.82；95%CI，1.88 - 4.25）和长期随访死亡（调整后HR 2.44；95%CI，1.73 - 3.42）显著相关。与接种疫苗的患者相比，未接种疫苗的患者出院时接受RRT的几率高2.56倍（95%CI，1.52 - 4.30）。在调整后的多变量分析中，与接种疫苗的患者相比，未接种疫苗的患者住院死亡率（调整后HR 5.54；95%CI，3.36 - 9.13）和长期随访死亡率（调整后HR 4.78；95%CI，3.39 - 6.73）均显著增加。
缺乏接受CRRT的重症监护病房患者的通气状态和其他感染严重程度指标的数据。此外，缺乏COVID-19加强疫苗接种的数据。
COVID-19感染合并AKI的接种疫苗患者总体生存率更高，出院时继续接受RRT的可能性更小。进一步研究评估AKI的潜在病因以及接种疫苗和未接种疫苗的COVID-19感染患者的肾脏结局，对于制定针对性治疗方案、指导管理和随访方法以监测肾脏恢复情况以及为这些患者提供慢性肾脏病护理的结局模型具有重要意义。
