Impact of COVID-19-associated AKI on subsequent development of CKD

Background: There is paucity of data about post-hospital discharge kidney-related outcomes in individuals with COVID-19-associated acute kidney injury (CoV-AKI) during the pandemic. We hypothesized that patients who survive a hospital admission due to COVID-19 and AKI are at risk for acquiring residual chronic kidney disease (CKD) thereafter. Methods: We conducted a retrospective observational study examining records of patients hospitalized at Ochsner Medical Center over a 3-month period (March-May 2020) with COVID-19 and diagnosis of AKI by KDIGO. We examined the rate of full recovery of AKI (serum creatinine value back to within 10% of baseline or < 1.2 mg/dL) at 9 months post-hospital discharge. Factors associated with recovery were assessed. Results: Among 916 admissions due to COVID-19 within the study [220 (24%) to an intensive care unit], there were 226 (26%) cases of AKI, 98 of them (43%) with AKIrequiring dialysis (AKI-RRT). Patients with CoV-AKI had a median age of 67 (34-99) and 58% were men. Self-identified black race accounted for 65% of the cohort. Among those with CoV-AKI, there were 111 in-hospital deaths (49%). Of 115 patients with CoVAKI who were discharged alive, 9-month follow-up data were retrieved in 97 (missing data in 18). Full recovery of kidney function was achieved by 76 (78%). Among those who progressed to residual CKD, 11 (11%) patients were declared to have end-stage kidney disease (ESKD) requiring dialysis. Baseline CKD stages 3-5 was associated with lower rate of full renal recovery [23/76 (30%) vs. 14/23 (61%);RR: 2.01, p=0.004)]. Conclusions: Full recovery from CoV-AKI was observed in of those who remain alive post-hospital discharge. About 1/10th of patients with CoV-AKI reached ESKD at intermediate-term follow-up. Preexisting CKD is associated with lower rate of recovery in CoV-AKI. These data do not seem to suggest that CoV-AKI is associated with greater risk for development of CKD compared to other forms of in-hospital AKI.