Comparison of Acute Kidney Injury in Patients with COVID-19 and Other Respiratory Infections: A Prospective Cohort Study - Diebold, M.; Zimmermann, T.; Dickenmann, M.; Schaub, S.; Bassetti, S.; Tschudin-Sutter, S.; Bingisser, R.; Heim, C.; Siegemund, M.; Osswald, S.; Kuster, G. M.; Rentsch, K. M.; et al. (J Clin Med, 2021)
Previous studies have indicated an association between coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) but lacked a control group. The prospective observational COronaVIrus-surviVAl (COVIVA) study performed at the University Hospital, Basel, Switzerland consecutively enrolled patients with symptoms suggestive of COVID-19. We compared patients who tested positive for SARS-CoV-2 with patients who tested negative but with an adjudicated diagnosis of a respiratory tract infection, including pneumonia. The primary outcome measure was death at 30 days, and the secondary outcomes were AKI incidence and a composite endpoint of death, intensive care treatment or rehospitalization at 30 days. Five hundred and seven patients were diagnosed with respiratory tract infections, and of those, 183 (36%) had a positive PCR swab test for SARS-CoV-2. The incidence of AKI was higher in patients with COVID-19 (30% versus 12%, p < 0.001), more severe (KDIGO stage 3, 22% versus 13%, p = 0.009) and more often required renal replacement therapy (4.4% versus 0.93%; p = 0.03). The risk of 30-day mortality and a composite endpoint was higher in patients with COVID-19-associated AKI (adjusted hazard ratio (aHR) mortality 3.98, 95% confidence interval (CI) 1.10-14.46, p = 0.036; composite endpoint aHR 1.84, 95% CI 1.02-3.31, p = 0.042). The mortality risk was attenuated when adjusting for disease severity (aHR 3.60, 95% CI 0.93-13.96, p = 0.062). AKI occurs more frequently and with a higher severity in patients with COVID-19 and is associated with worse outcomes.
Keywords: journalArticle; (Grant No P300PB_167803); Abbott, Amgen, Astra Zeneca, Roche, Siemens, Singulex and Thermo Scientific; Akademische Gesellschaft Basel outside of this work. S. Tschudin-Sutter is a; Anti-infectives Advisory Board and the Menarini Scientific Advisory Board. She; BRAHMS. Zimmermann reports a personal research grant by the Freiwillige; Basel and the Jubilaumsstiftung from Swiss Life. Kuster reports research support; Cardiology; Cardiovascular Research Foundation Basel that are unrelated to this work and; Covid-19; Department of Internal Medicine University Hospital Basel, Abbott and Roche, as; National Science Foundation (PASMP3-134362), the University of Basel, the; SARS-CoV-2; acute kidney injury; and (320030_197901), the Gottfried und Julia Bangerter-Rhyner Stiftung, the Fonds; and the University Hospital Basel and speaker honoraria/consulting honoraria from; consultant fees from Janssen. Breidthardt received research grants from the Swiss; from the Swiss National Science Foundation (Grant No IZCOZ0_189877) and the; member of the Astellas and MSD Advisory Boards for C. difficile of the Pfizer; mortality; pneumonia; reports grants from the Swiss National Science Foundation NRP72 (407240_167060); respiratory tract infection; the Cardiovascular Research Foundation Basel; the Swiss Heart Foundation; the Swiss Society of; the University of Basel; well as speakers honoraria from Roche; zur Forderung von Lehre und Forschung der Freiwilligen Akademischen Gesellschaft