The dynamics and outcomes of AKI progression during the COVID‐19 pandemic

Abstract Purpose Acute kidney injury (AKI) associated with COVID‐19 is associated with poor prognosis. This study assessed the hitherto uninvestigated impact of COVID‐19 on the progression and clinical outcomes of patients with AKI. Methods Data from 576 patients with AKI admitted between 13/3/20 and 13/5/20 were studied. Increasingly complex analyses, from logistic regressions to competing‐risk and multi‐state models, have revealed insights into AKI progression dynamics associated with PCR‐confirmed COVID‐19 acquisition and death. Meta‐analyses of case fatality ratios among patients with AKI were also conducted. Results The overall case‐fatality ratio was 0.33 [95% CI (0.20–0.36)]; higher in COVID‐19 positive (COVID+) patients 0.52 [95% CI (0.46–0.58)] than in their negative (COVID‐) counterparts 0.16 [95% CI (0.12–0.20)]. In AKI Stage‐3 patients, that was 0.71 [95% CI (0.64–0.79)] among COVID+ patients with 45% dead within 14 days and 0.35 [95% CI (0.25–0.44)] in the COVID‐ group and 28% died within 14 days. Among patients diagnosed with AKI Stage‐1 within 24 h, the probability of progression to AKI Stage‐3 on day 7 post admission was 0.22 [95% CI (0.17–0.27)] among COVID+ patients, and 0.06 [95% CI (0.03, 0.09)] among those who tested negative. The probability of discharge by day 7 was 0.71 [95% CI (0.66, 0.75)] in COVID‐ patients, and 0.27 [95% CI (0.21, 0.32)] in COVID+ patients. By day 14, in AKI Stage‐3 COVID+ patients, that was 0.35 [95% CI (0.25, 0.44)] with little change by day 10, that is, 0.38 [95% CI (0.29, 0.47)]. Conclusion These results are consistent with either a rapid progression in severity, prolonged hospital care, or high case fatality ratio among AKI Stage‐3 patients, significantly exacerbated by COVID‐19 infection. image