Acute kidney injury (AKI) was reported in more than a quarter of hospitalised patients with COVID-19.
Most risk factors for community- and hospital-acquired AKI were common, pointing to a predominantly pre-renal mechanism of injury.
Hospital-acquired AKI, but not community-acquired AKI, was a significant risk factor for COVID-19-related mortality.
Why this matters
Future studies are warranted to determine the pathophysiology of AKI in patients with COVID-19, particularly regarding thrombotic disease, and to determine whether it differs between community- and hospital-acquired AKI.
Researchers at Salford Royal Hospital in England conducted a retrospective cohort study of 448 patients who tested positive for COVID-19 (March-June 2020).
Patients were stratified into community-acquired AKI and hospital-acquired AKI based on the timing of AKI onset.
Of 448 patients with COVID-19, 118 (26.3%) recorded AKI (57 community-acquired; 61 hospital-acquired) during hospital admission.
Chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure (SBP) and respiratory rate were significant independent risk factors for community-acquired AKI.
CKD, trough SBP, peak heart rate, peak CRP and trough lymphocytes were significant independent risk factors for hospital-acquired AKI.
Invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted OR [aOR], 9.1; 95% CI, 3.63-22.80; P<.0001).
Patients with AKI vs those without had a higher mortality risk (54.3% vs 29.4%; P<.0001).
Hospital-acquired AKI (adjusted HR, 4.64; 95% CI, 2.98-7.23; P<.0001), but not community-acquired AKI, was significantly associated with an increased risk of COVID-19-related mortality.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
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Cite this: Pavankumar Kamat. COVID-19: Hospital-acquired vs Community-acquired Acute Kidney Injury - Medscape - Aug 13, 2021.