COVID-19-associated AKI in hospitalized US patients: incidence, temporal trends, geographical distribution, risk factors and mortality

Background: Acute kidney injury (AKI) is associated with mortality in patients hospitalized with COVID-19, however, its incidence, geographic distribution, and temporal trends since the start of the pandemic are understudied. Methods: Electronic health record data were obtained from 53 health systems in the United States (US) in the National COVID Cohort Collaborative (N3C). We selected hospitalized adults diagnosed with COVID-19 between March 6th, 2020, and January 6th, 2022. AKI was determined with serum creatinine (SCr) and diagnosis codes. Time were divided into 16-weeks (P1-6) periods and geographical regions into Northeast, Midwest, South, and West. Multivariable models were used to analyze the risk factors for AKI or mortality. Results: Out of a total cohort of 306,061, 126,478 (41.0 %) patients had AKI. Among these, 17.9% lacked a diagnosis code but had AKI based on the change in SCr. Similar to patients coded for AKI, these patients had higher mortality compared to those without AKI. The incidence of AKI was highest in P1 (49.3%), reduced in P2 (40.6%), and relatively stable thereafter. Compared to the Midwest, the Northeast, South, and West had higher adjusted AKI incidence in P1, subsequently, the South and West regions continued to have the highest relative incidence. In multivariable models, AKI defined by either SCr or diagnostic code, and the severity of AKI was associated with mortality. Conclusions: Uncoded cases of COVID-19-associated AKI are common and associated with mortality. The incidence and distribution of COVID-19-associated AKI have changed since the first wave of the pandemic in the US.

[1]  H. Lehmann,et al.  Harmonizing units and values of quantitative data elements in a very large nationally pooled electronic health record (EHR) dataset , 2022, J. Am. Medical Informatics Assoc..

[2]  Hong Yu,et al.  Differential COVID-19 Symptoms Given Pandemic Locations, Time, and Comorbidities During the Early Pandemic , 2022, Frontiers in Medicine.

[3]  D. Adam.  The pandemic’s true death toll: millions more than official counts , 2022, Nature.

[4]  J. Saltz,et al.  Short- and Long-Term Recovery after Moderate/Severe AKI in Patients with and without COVID-19 , 2021, Kidney360.

[5]  L. Fritsche,et al.  Changes in COVID-19-related outcomes, potential risk factors and disparities over time , 2021, Epidemiology and Infection.

[6]  K. Gersing,et al.  Children with SARS-CoV-2 in the National COVID Cohort Collaborative (N3C) , 2021, medRxiv.

[7]  Andrew E. Williams,et al.  Clinical Characterization and Prediction of Clinical Severity of SARS-CoV-2 Infection Among US Adults Using Data From the US National COVID Cohort Collaborative , 2021, JAMA network open.

[8]  S. O’Rahilly,et al.  Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study , 2021, The Lancet Diabetes & Endocrinology.

[9]  Scott L. Bain,et al.  COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study , 2021, The Lancet.

[10]  C. Macaya,et al.  Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry , 2021, Obesity Research & Clinical Practice.

[11]  H. Sørensen,et al.  Body Mass Index and 90-Day Mortality Among 35,406 Danish Patients Hospitalized for Infection. , 2021, Mayo Clinic proceedings.

[12]  M. Xiang,et al.  COVID-19 patients with hypertension are at potential risk of worsened organ injury , 2021, Scientific Reports.

[13]  P. Brennan,et al.  Characteristics, Outcomes, and Trends of Patients With COVID-19–Related Critical Illness at a Learning Health System in the United States , 2021, Annals of Internal Medicine.

[14]  Philip R. O. Payne,et al.  The National COVID Cohort Collaborative (N3C): Rationale, design, infrastructure, and deployment , 2020, J. Am. Medical Informatics Assoc..

[15]  L. Magder,et al.  Impact of Sex and Metabolic Comorbidities on Coronavirus Disease 2019 (COVID-19) Mortality Risk Across Age Groups: 66 646 Inpatients Across 613 U.S. Hospitals , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  N. Rosenthal,et al.  Risk Factors Associated With In-Hospital Mortality in a US National Sample of Patients With COVID-19 , 2020, JAMA network open.

[17]  Benjamin Bowe,et al.  Acute Kidney Injury in a National Cohort of Hospitalized US Veterans with COVID-19. , 2020, Clinical journal of the American Society of Nephrology : CJASN.

[18]  Yan-Mei Huang,et al.  Obesity in patients with COVID-19: a systematic review and meta-analysis , 2020, Metabolism.

[19]  Lucy Lu Wang,et al.  Modelling kidney disease using ontology: insights from the Kidney Precision Medicine Project , 2020, Nature Reviews Nephrology.

[20]  M. Talamini,et al.  Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study , 2020, Open forum infectious diseases.

[21]  E. Seminari,et al.  The obesity paradox: analysis from the SMAtteo COvid-19 REgistry (SMACORE) cohort , 2020, Nutrition, Metabolism and Cardiovascular Diseases.

[22]  M. Dimopoulos,et al.  Predictors of adverse prognosis in COVID‐19: A systematic review and meta‐analysis , 2020, European journal of clinical investigation.

[23]  Mild AKI is associated with mortality of patients who underwent cardiopulmonary bypass surgery , 2020, Experimental and therapeutic medicine.

[24]  J. Neugarten,et al.  AKI in Hospitalized Patients with and without COVID-19: A Comparison Study. , 2020, Journal of the American Society of Nephrology : JASN.

[25]  S. Dabernat,et al.  Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019 , 2020, Clinical kidney journal.

[26]  Kenar D. Jhaveri,et al.  Acute kidney injury in patients hospitalized with COVID-19 , 2020, Kidney International.

[27]  Eun Ji Kim,et al.  Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. , 2020, JAMA.

[28]  Lei Dong,et al.  Kidney disease is associated with in-hospital death of patients with COVID-19 , 2020, Kidney International.

[29]  E. Mascha,et al.  Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Long-term Renal Dysfunction , 2020, Anesthesiology.

[30]  George Hripcsak,et al.  Facilitating phenotype transfer using a common data model , 2019, J. Biomed. Informatics.

[31]  Chia-Yi Wu,et al.  The severity of initial acute kidney injury at admission of geriatric patients significantly correlates with subsequent in-hospital complications , 2015, Scientific Reports.

[32]  Sushrut S Waikar,et al.  Performance and limitations of administrative data in the identification of AKI. , 2014, Clinical journal of the American Society of Nephrology : CJASN.

[33]  Cedric E. Ginestet.  ggplot2: Elegant Graphics for Data Analysis , 2011 .

[34]  C. McCulloch,et al.  Community-based incidence of acute renal failure. , 2007, Kidney international.

[35]  Sushrut S Waikar,et al.  Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure. , 2006, Journal of the American Society of Nephrology : JASN.