Abstract: PO0014
AKI in COVID-19: Risk Factors for Mortality and Estimating Burden Using an ARIMA Model
Session Information
- COVID-19: AKI and Basic Science
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Jana, Kundan, Maimonides Medical Center, Brooklyn, New York, United States
- Janga, Kalyana C., Maimonides Medical Center, Brooklyn, New York, United States
- Greenberg, Sheldon, Maimonides Medical Center, Brooklyn, New York, United States
Background
Incidence of Acute Kidney Injury (AKI) among COVID-19 patients is 35%. Requirement for Renal replacement therapy (RRT) is estimated to be 15%-20%. We aimed to identify risk factors associated with mortality and need for RRT in COVID-19 patients with AKI. We also estimated burden of the pandemic on inpatient hemodialysis (HD) unit.
Methods
Inpatients above 18 years, diagnosed with COVID-19 on RT-PCR between March-June 2020 were included in the study. AKI was defined using KDIGO guidelines. Data collected included demographics, serum creatinine, time to AKI, comorbidities, albuminuria, need for RRT and intubation. All inpatient HD sessions from January 2016 to June 2020 were included to estimate burden of COVID-19. CVVHD, PIRRT and PD were excluded. Statistical analysis included logistic regression, ANOVA, z-test for proportions and Chi-square test. Interrupted time series analysis using Auto Regression Interference and Moving Average (ARIMA) was used to predict proportion of bedside HD sessions from January 2020.
Results
1991 patients positive for COVID-19 on RT-PCR were included. 683 (34.2%) were found to have AKI. 185 patients (27.1%) required RRT. Mortality among AKI patients was 64.7%. Age (OR=1.04; CI 1.03 to 1.06), AKI after 1 week (OR=2.15; CI 1.06 to 4.35), albuminuria (OR=2.57; CI 1.11 to 5.93), need for RRT (OR=2; CI 1.26 to 3.19) and intubation (OR=4.6; CI 2.71 to 7.75) were the mortality risk factors. Albuminuria (OR=2.97; CI 1.04 to 8.46), CKD (OR=3.5; CI 1.67 to 7.34) and intubation (OR=7.8; CI 5.14 to 11.91) were the risk factors for RRT. Diabetes and hypertension did not increase mortality or the need for RRT. To estimate the burden of pandemic, 24086 HD sessions between Jan. 2016 to June 2020 were analyzed. Proportion of bedside HD was significantly higher in 2020 when compared to previous years (p<0.01) due to isolation protocols. ARIMA model showed a significant difference in the mean proportion of bedside HD sessions for 2020 between observed and expected values (p<0.01). Personnel requirement showed an extra burden of 870 nurse-hours with March-April accounting for 76%. This was due to increased number of bedside sessions requiring a 1:1 nurse-patient ratio as opposed to in unit sessions where nurse-patient ratio is 1:2.
Conclusion
Time to AKI, albuminuria and RRT are important risk factors for mortality in COVID-19 patients with AKI.