Association of antiplatelet and anticoagulation therapy with dialysis-requiring AKI in critically ill patients with COVID-19

Background: Acute kidney injury(AKI) affects 22% of hospitalised patients and is associated with a 21 9% increased risk of mortality in non COVID-19 admissions Based on reports from China the rate of AKI in patients hospitalised with COVID-19 is 3-9% The study's objective was to identify AKI prevalence in COVID-19 patients and associated adverse outcomes Methods: This is a retrospective observational cohort study of patients admitted to hospital with positive COVID-19 PCR testing from 14th February to 7th May 2020 Demographic data, past medical history and blood results were obtained from health records AKI was defined according to KDIGO criteria Results: 383 patients (220 Male) were included in the final analysis, with an age range of 18-99 yrs(median 69 yrs) AKI occurred in 153(39 9%) patients (103 male), with a median age of 74 years 111(72 5%) patients had AKI on admission, 42(27 5%) developed AKI while hospitalised Average clinical frailty score (CFS) in the AKI group was 4 Median creatinine kinase in the AKI group was 213iu/L(IQR 149-1260) Of all 153 AKI patients;100(65 4%) were in Stage 1, 29(19%) in Stage 2 and 24(15 7%) in Stage 3 14(9 2%) patients required renal replacement therapy (RRT) with 7(50%) becoming dialysis independent 3 patients died and 4 transferred to specialist units for treatment whilst on RRT Mean peak serum creatinine of 246umol/L was observed on Day 5 of admission and Day 11 of symptoms on average 90/153(58 5%) patients had recovery of renal function 40/76(53%) patients who required CPAP or mechanical ventilation respiratory support had evidence of AKI compared to 113/304(37%) of non-ventilated patients Of all 153 AKI patients, 61(39%) deaths occurred compared to 43/228(19%) in the non-AKI group This difference was significant, p<0 01, OR= 2 89 (95% CI: 1 81, 4 58) suggesting that patients with AKI had a 74% chance of increased death Univariate analysis showed that age, males, baseline eGFR, albumin, CFS and Charlson comorbidity index were predictors of AKI Multivariate analysis showed that independent predictors of AKI included males, Black and Asian race, baseline eGFR and albumin An increase in baseline eGFR by 1ml/min in COVID-19 patients was associated with a 2 4% risk reduction in death, p<0 01, OR= 0 976 (95% CI: 1 02, 1 03)