WCN23-0874 A cross-sectional study of the prevalence and outcomes of acute kidney injury in patients with Covid 19 at a tertiary hospital in Nairobi

Document Type

Article

Department

Family Medicine (East Africa); Internal Medicine (East Africa)

Abstract

Introduction: AKI has been shown to be more prevalent in COVID-19 patients across the disease spectrum compared to non-COVID patients. Black race is an independent risk factor for AKI in COVID-19 patients, with an AKI prevalence ranging from 1.3-2.5 times that of other races. Reasons for this difference include socioeconomic disadvantages, increased and uncontrolled use of nephrotoxic drugs and a higher prevalence of poorly controlled comorbid conditions in the Black population. The objective of our study was to determine the preva- lence, risk factors and outcomes of AKI in patients hospitalized with COVID-19 in Kenya.

Methods: This retrospective cohort study included 1366 patients with confirmed COVID-19 illness hospitalized at a tertiary level teaching hospital in Kenya between April 1st, 2020 and October 31st, 2021. Data was collected on age, gender, the severity of COVID-19 illness, and comorbid conditions including HIV, diabetes, hypertension, CKD and post-renal transplant patients. Univariate analysis was carried out to determine the association of clinical and demographic factors with AKI. To determine independent associations with AKI incidence, a logistic regression model was used and the relationship was reported as odds ratios with a 95% confidence interval. The primary outcome of AKI in COVID-19 patients in this study is the in-hospital mortality rate. Other secondary outcomes assessed include the status of renal recovery at hospital discharge and the duration of hospital stay.

Results: The median age of study patients was 56 years with 67% of them being male. The AKI prevalence in the study period was 21.6% (n=295).Patients with AKI were older more likely to be male. Comorbid conditions related to the development of AKI in COVID-19 patients in our setting include diabetes and hyperten- sion, with an adjusted odds ratio of 1.75 (95% CI 1.34-2.30; p value <0.001) and 1.68 (95% CI 1.27-2.23; p value <0.001) respectively. Chronic kidney disease was also associated with AKI incidence, with an adjusted odds ratio of 2.70 (95% CI 1.86-3.93; p value <0.001). Patients with AKI had significantly higher odds of mor- tality when compared to those without AKI, and this effect was proportional to the stage of AKI. In this study, COVID-19 patients with AKI were 11 times more likely to die while hospitalized (95% CI 7.56-17.03; p value <0.001), with mortality seen in 65% of patients with stage 3 AKI as compared to 18% of patients with stage 1 AKI. In terms of renal recovery at hospital discharge, 95% of patients with stage 1 AKI had complete renal recovery vs 33% of patients with stage 3 AKI. Of the patients with stage 3 AKI (n=64), 10 underwent hemodialysis, with 1 recovery in renal function and 3 patients requiring ongoing dialysis after discharge. Lastly, patients with AKI had a longer hospital stay (10 days [IQR 5-18] vs 8 days [IQR 5-10]; P<0.001).

Conclusions: We found significantly higher odds of AKI with increasing age, gender, hypertension, diabetes, chronic kidney disease and severity of COVID-19 illness. We found no association between AKI and pregnancy or comorbid conditions like HIV and post-renal trans- plant. In this study, we demonstrated a strong independent association between AKI in COVID-19 and mortality. The study also showed the impact of AKI on hospital duration and the effect of COVID-19 disease on renal recovery in AKI patients.

Publication (Name of Journal)

Kidney International Reports

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