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Kidney Week

Abstract: SA-OR24

Longitudinal Kidney Outcomes of COVID-19-Associated AKI

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Aklilu, Abinet Mathias, Yale School of Medicine, New Haven, Connecticut, United States
  • Kumar, Sanchit, Yale School of Medicine, New Haven, Connecticut, United States
  • Nugent, James, Yale School of Medicine, New Haven, Connecticut, United States
  • Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States

Group or Team Name

  • Clinical and Translational Research Accelerator.
Background

COVID-19 infection is associated with a high incidence of acute kidney injury(AKI). The long-term impact of COVID-associated AKI on kidney function trajectory remains unknown.

Methods

This was a longitudinal health record cohort study that included 9624 adults hospitalized with AKI within a large New England health system assessing the association of COVID-19-associated AKI with the slope of estimated glomerular function rate (eGFR) for up to 2-yrs after discharge using multivariable linear mixed effects models. Three groups were compared: 1) patients hospitalized with COVID-19-associated AKI; 2) patients hospitalized during the COVID pandemic who tested negative for SARS CoV-2 and had AKI due to other causes (Other-AKI); and 3) patients hospitalized with influenza-associated AKI in the 5yrs before the COVID pandemic (Flu-AKI). A key secondary outcome included 2-yr major adverse kidney events (MAKE-a composite of mortality, ≥25% eGFR decline from discharge or end-stage kidney disease diagnosis) assessed using multivariable time-to-event analyses.

Results

The adjusted eGFR slope was -6.79ml/min/1.73m2 per year (95%CI -7.93,-5.64) following COVID-AKI, -5.55 (95%CI -7.45,-3.65) following Flu-AKI, and -2.60 (95%CI -3.01,-2.20) following Other-AKI. COVID-AKI was associated with lower 2-yr MAKE (adjHR: 0.67, 95%CI: 0.59-0.75), with lower 2-yr mortality (adjHR: 0.31, 95%CI: 0.24–0.39, p<0.001) and lower 2-yr renal progression (adjHR 0.78, 95%CI: 0.69–0.88, p<0.001) compared to Other-AKI.

Conclusion

While survivors of COVID-AKI experience an initial faster eGFR decline compared to AKI due to other causes, they have higher eGFR on discharge and exhibit lower rates of longitudinal renal progression and mortality.

Annualized rate of eGFR decline over 2yrs of follow up
Group NameUnadjusted eGFR Slope (ml/min/1.73m2 per year)p-interactionAdjusted eGFR Slope (ml/min/1.73m2 per year)p-interaction
COVID-AKI
Flu-AKI
Other-AKI
-6.86 (-8.00, -5.73)
-5.24 (-7.10, -3.37)
-2.50 (-2.90, -2.10)
<0.001
0.005
.
-6.79 (-7.93, -5.64)
-5.55 (-7.45, -3.65)
-2.60 (-3.01, -2.20)
<0.001
0.003
.

Funding

  • Other U.S. Government Support