Utilisation of a national database to characterise renal function in patients with COVID19 infection

Abstract

Rationale: The incidence of renal function alterations among patients with COVID19 is unknown.

Objective: To determine the incidence of acute kidney injury (AKI) or augmented renal clearance (ARC) in patients hospitalised with COVID19 and identify risk factors for patients who may exhibit each renal alteration.

Methods: Retrospective, observational cohort analysis of hospitalise, adult patients within the National COVID Cohort Collaborative (N3C) database with laboratory confirmed COVID19 and available data to calculate creatinine clearance using the Cockcroft–Gault equation from 1 January 2020 through 9 April 2022.

Measurements: Incidence of AKI or ARC and patient demographics.

Main results: 15 608 patients were included for renal function characterisation where 20.9% experienced AKI and 34.8% exhibited ARC. ARC lasted longer than AKI; however, AKI was associated with increased hospital length of stay and mortality. 11 274 patients were included in logistic regression analysis. Height and White race were the only variables associated with decreased risk of AKI while male sex and diabetes were associated with increased risk. Male sex, Black race and hypertension were associated with decreased risk of ARC. Age was associated with decreased risk of both AKI and ARC while weight and Hispanic ethnicity were associated with increased risk in both renal alterations.

Conclusions: A significant proportion of patients exhibit renal alterations during their hospitalisation for COVID19. These results provide initial evidence of identifying patients at risk of AKI or ARC, but more research is needed, especially with respect to use of biomarkers for renal alteration risk stratification.

Keywords

acute kidney injury / augmented renal clearance / COVID19 / renal function

References

[1] MekonnenS, IdA, AliSA, Mantfardo B, BasuB. Rate of intensive care unit admission and outcomes among patients with coronavirus: a systematic review and meta-analysis. PLoS One. 2020;15(7):e0235653.

[2] GavriatopoulouM, Korompoki E, FotiouD, et al. Organ-specific manifestations of COVID-19 infection. Clin Exp Med. 2020;20(4):493-506.

[3] SilverSA, Beaubien-Souligny W, ShahPS, et al. The prevalence of acute kidney injury in patients hospitalized with COVID-19 infection: a systematic review and meta-analysis. Kidney Med. 2021;3(1):83-98.

[4] BeundersR, van de Wijgert IH, van den BergM, van der HoevenJG, Abdo WF, PickkersP. Late augmented renal clearance in patients with COVID-19 in the intensive care unit. A prospective observational study. J Crit Care. 2021;64:7-9.

[5] MurtA, DincerMT, KaracaC. Augmented renal clearance in COVID-19. Nephron. 2021;145(4):386-387.

[6] SellesK, Van Der Mast J, VolbedaM, et al. Measured creatinine clearance and its impact on vancomycin levels in critically ill COVID-19 patients. Intensive Care Med Exp. 2020;8(2). SUPPL.

[7] Tomasa-IrriguibleTM, Martínez-Vega S, Mor-MarcoE, Herraiz-RuizA, Raguer-Pardo L, Cubells-LarrosaC, Low molecular weight heparins in COVID-19 patients: beware of augmented renal clearance! Crit Care. 2020;24(325):1-2.

[8] RhoneyDH, BrooksAB, NelsonNR. Augmented renal clearance: an under-recognized phenomenon associated with COVID-19. Crit Care Explor. 2022;4(2):e0617.

[9] GabarreP, DumasG, DupontT, Darmon M, AzoulayE, ZafraniL. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020;46(7):1339-1348.

[10] HaendelMA, ChuteCG, BennettTD, et al. The National COVID Cohort Collaborative (N3C):rationale, design, infrastructure, and deployment. J Am Med Inform Assoc. 2021;28(3):427-443.

[11] FitzhenryF, ResnicFS, RobbinsSL, et al. Creating a common data model for comparative effectiveness with the observational medical outcomes partnership. Appl Clin Inform. 2015;6(3):536-547.

[12] von ElmE, AltmanDG, EggerM, Pocock SJ, GøtzschePC, VandenbrouckeJP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453-1457.

[13] LittleJ, RubinD. Statistical Analysis with Missing Data. 3rd ed.. Wiley; 2019.

[14] KDIGO 2012 clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Int Suppl (2011). 2013;3:1-150.

[15] CockcroftDW, GaultMH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.

[16] ArikanH, OzturkS, TokgozB, et al. Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: a multicenter study by the Turkish society of nephrology. PLoS One. 2021;16(8):e0256023.

[17] CaiX, WuG, ZhangJ, Yang L. Risk factors for acute kidney injury in adult patients with COVID-19: a systematic review and meta-analysis. Front Med (Lausanne). 2021;8:719473.

[18] NimkarA, Naaraayan A, HasanA, et al. Incidence and risk factors for acute kidney injury and its effect on mortality in patients hospitalized from COVID-19. Mayo Clin Proc Innov Qual Outcomes. 2020;4(6):687-695.

[19] YooYJ, Wilkins KJ, AlakwaaF, et al. Geographic and temporal trends in COVID-associated acute kidney injury in the national COVID cohort collaborative. Clin J Am Soc Nephrol. 2023;18:1006-1018.

[20] Martín-del-CampoF, Ruvalcaba-ContrerasN, Velázquez-Vidaurri AL, et al. Morbid obesity is associated with mortality and acute kidney injury in hospitalized patients with COVID-19. Clin Nutr ESPEN. 2021;45:200-205.

[21] BakdachD, ElajezR, BakdachAR, Awaisu A, De PascaleG, Ait HssainA. Pharmacokinetics, pharmacodynamics, and dosing considerations of novel β-lactams and β-lactam/β-lactamase inhibitors in critically ill adult patients: focus on obesity, augmented renal clearance, renal replacement therapies, and extracorporeal membrane oxygenation. J Clin Med. 2022;11(23):6898.

RIGHTS & PERMISSIONS

2024 The Author(s). Clinical and Translational Discovery published by John Wiley & Sons Australia, Ltd on behalf of Shanghai Institute of Clinical Bioinformatics.