Clinical characteristics and outcomes of COVID-19 patients with AKI at community-based hospital

Background: The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and later called Covid-19 has resulted in significant morbidity worldwide. The virus can cause various complications and affect many organ systems. Preliminary reports have shown that Acute Kidney Injury (AKI) is common in patients with Covid-19, however, outcomes of kidney injury in hospitalized patients, especially at the communitybased hospitals are not well described. The aim of this study was to describe the incidence, severity, and outcomes of Covid-19 patients with AKI at the community-based hospital. Methods: This was a single-center, retrospective observational cohort study. All patients (age ≥18) with positive by polymerase chain reaction testing for Covid-19 who required hospitalization were included in the study. Patients with End-Stage Kidney Disease and kidney transplants were excluded. We compared outcomes of patients with and without AKI. We used univariable and multivariable Cox regression model to evaluate the relationship between AKI and in-hospital mortality. Results: 220 patients were included in the study. 89 (40%) patients developed AKI, of whom 6 (7%) required Kidney replacement therapy (KRT) and 131 (60%) did not develop AKI. In-hospital mortality of patients with AKI was markedly higher than patients without AKI. Among the patients with AKI, 39 (43.8%) experienced in-hospital death while in patients without AKI, 23 (17.5%) died (P<0.001). Unadjusted HR was 2.01 (CI 1.23-3.14;P<0.001). The risk of in-hospital death remained significantly high following adjustment for baseline demographics and comorbidities with adjusted HR 1.8 (CI 1.50-2.74, P=0.015). The median hospital length of stay of patients who were discharged alive differed based upon AKI status. Patients with AKI-KRT had the longest median length of stay (15.5 days IQR 8.5-23.7), followed by patients with AKI non-KRT (7 days, IRQ 5-14) and patients without AKI (6 days, IQR 4-10). Conclusions: AKI is a common condition among patients hospitalized with Covid-19 and is associated with an increased risk of in-hospital mortality. It is important to consider this complication in the management of Covid-19 patients.