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Abstract: FR-PO058

Incidence of COVID-19-Associated AKI: Effect of Time

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Jurkovitz, Claudine T., Christiana Care Health Services Inc, Wilmington, Delaware, United States
  • Caplan, Richard, Christiana Care Health Services Inc, Wilmington, Delaware, United States
  • Ndura, Kevin, Christiana Care Health Services Inc, Wilmington, Delaware, United States
  • Vest, Michael T., Christiana Care Health Services Inc, Wilmington, Delaware, United States
Background

Acute Kidney Injury (AKI) is a known complication of COVID-19. Recent reports have suggested a decrease in AKI incidence with time. The objective of this study was to evaluate the incidence of AKI over time and determine whether changes in patients’ characteristics could explain this decrease.

Methods

Data were selected from the Cerner Real-World DataTM, a cloud-based platform of de-identified electronic health records data from >100 health systems. Our study population was defined as hospitalized adults with COVID-19 in 2020-2021. We excluded patients with known end-stage kidney disease and those whose first interaction with the health system was the COVID-related hospitalization. AKI was defined as an increase in serum creatinine by ≥0.3 mg/dl within 48 hours or ≥1.5 times the baseline. We used logistic regression to estimate the association between time categorized in quarters and occurrence of AKI after adjusting for demographic variables and comorbidities identified from the Elixhauser ICD10-based algorithm. To determine whether the effect of demographic and comorbidities on the likelihood of AKI varied with time, we also ran separate logistic regression models for each quarter.

Results

Our analytical dataset included 152,296 patients. Of those 49% were female, 12% black, 71% white, 29% Hispanic, mean age was 61±19, 32% had diabetes, 55% hypertension, 14% Kidney Disease, 20% coronary artery disease, 14% congestive heart failure, 24% COPD, 10% liver disease and 21% developed AKI while hospitalized. The incidence of AKI decreased from 28% in 2020 quarter one (2020Q1) to 19% in 2021Q4 (test of trend p<0.001). The odds of developing AKI for 2020Q2 to 2021Q4 compared to 2020Q1 were Odds Ratio=0.80, 95% CI 0.72-0.89, 0.73 (0.66-0.81), 0.72 (0.66-0.80), 0.72 (0.65-0.80), 0.58 (0.53-0.65), 0.67 (0.60-0.74), 0.61 (0.52-0.71) respectively. After adjusting for covariates, the effect of time although attenuated (highest 2020Q2 OR=0.79 (0.71-0.88), lowest 2021Q4 OR=0.67 (0.58-0.79) remained significant. Time did not modify the effect of the demographic variables and comorbidities on developing AKI.

Conclusion

The decrease in AKI incidence with time is independent of the effect of demographic risk factors and comorbidities. This decrease is likely related to improvement in patients volume management, treatment with steroids, anticoagulation and early treatment of the virus.

Funding

  • Other NIH Support