Impact of Hospital-acquired Acute Kidney Injury on Covid-19 Outcomes in Patients with and without Chronic Kidney Disease: A multicentre, retrospective cohort study.

AAbstract Background/aim: Hospital-acquired acute kidney injury (HA-AKI) may commonly develop in Covid-19 patients and is expected to have higher mortality. There is little comparative data looking for the effect of HA-AKI on mortality of chronic kidney disease (CKD) patients and a control group of general population suffering from Covid-19. MATERIALS AND METHODS: HA-AKI development was assessed in a group of stage 3-5 CKD patients and control group without CKD among adult patients hospitalized for Covid-19. The role of AKI development on the outcome (in-hospital mortality and admission to the intensive care unit [ICU]) of patients with and without CKD was compared. RESULTS: Among 621 hospitalized patients (age 60 [IQR:47-73]), women: 44.1%), AKI developed in 32.5% of the patients, as stage 1 in 84.2%, stage 2 in 8.4% and, stage 3 in 7.4%. AKI developed in 48.0 % of CKD patients, whereas in 17.6% of patients without CKD. CKD patients with HA-AKI had the highest mortality rate of 41.1 % compared to 14.3 % of patients with HA-AKI but no CKD (p<0.001). However, patients with AKI+non-CKD had similar rates of ICU admission, mechanical ventilation, and death rate as patients with CKD without AKI. Adjusted mortality risk of the AKI+non-CKD group (HR: 9.0, 95%CI:1.9-44.2) and AKI+CKD group (HR: 7.9, 95%CI:1.9-33.3) were significantly higher than non-AKI+non-CKD group. CONCLUSION: AKI frequently develops in hospitalized patients due to Covid-19 and is associated with high mortality. HA-AKI has worse outcome whether it develops in patients with or without CKD, but the worst outcome was seen in AKI+CKD patients.