Infectious Disease

AKI more common, more severe in patients with COVID-19 compared to influenza

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Birkelo does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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AKI was more common in hospital admissions for COVID-19 than influenza, with study results suggesting that AKI with the former led to more severe outcomes, including the need for mechanical ventilation and increased mortality.

In patients who survived after 90 days, the rates of recovery in renal function were similar in both groups at 90%.

AKI in COVID-19 vs. influenza

Data was derived from Birkelo BC et al. Kidney int. 2021; doi: 10.1016 / j.kint.2021.05.029.

“Acute kidney injury is a common complication in patients hospitalized with SARSCoV-2 (COVID-19), with previous studies implying several potential mechanisms of injury.” Bethany C. Birkelo, DO, from the Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, and colleagues wrote. “Although COVID-19 is often compared to other respiratory viral diseases, there are few formal comparisons of these viruses with kidney health. In this retrospective cohort study, we compared the incidence, characteristics, and outcomes of acute kidney injury in veterans hospitalized with COVID-19 or influenza, and adjusted them to baseline using weighted comparisons. “

Using electronic medical records, Birkelo and colleagues identified 3,402 hospitalizations for COVID-19 and 3,680 hospitalizations for influenza between October 2019 and May 2020.

“In order to control possible seasonal, temporal or erratic effects in the early pandemic, we carried out a sensitivity analysis that adjusted the recording date as a continuous variable with a five-node spline in the weighting of the inclination rating,” the researchers wrote on that patients in both groups were of similar age, but those hospitalized with COVID-19 were more likely to be African American patients.

AKI in COVID-19 vs. influenza

A comparison of the AKI incidence between the two diseases showed a higher prevalence of AKI in hospital admissions for COVID-19 than in influenza (41% vs. 29%), with the severity of the AKI stage in patients with COVID-19 also being higher .

An analysis of inpatient characteristics revealed differences between the groups, with oxygen saturation less than 88% found in 26% of patients with COVID-19 and 14% of patients with influenza. Patients in the COVID-19 group required mechanical ventilation more frequently (17% vs. 3%) and received vasopressors (13% vs. 2%).

In terms of mortality, researchers observed higher rates of inpatient deaths (30% vs. 3%) and deaths 90 days after the peak of serum creatinine (35% vs. 9%) among patients in the COVID-19 group.

“While this finding underscores the high AKI-related mortality rate in COVID-19, it also offers some optimism for recovery in those who survive the disease, as approximately 90% of non-dialysis AKI survivors have recovered,” wrote the explorers.

Further observations showed that more patients in the COVID-19 group required renal replacement therapy (13% vs. 2%) and that these patients were more likely to remain on dialysis when they were discharged from the hospital (8% vs. 1%).

AKI load, resource allocation

“Our results have important implications for resources,” wrote Birkelo and colleagues. “We observed a significant incidence of AKI in influenza, with a quarter of patients developing AKI while in hospital. It remains to be seen what impact mask wear and social distancing will have on influenza incidence in the current and future influenza season. Regardless, the potential additional exposure to AKI related to influenza on top of AKI during a hospital stay with COVID-19 could have a downstream impact on resource use …

Given the burden on the health system from COVID-19, it will be important to forecast the overall increased burden of kidney diseases and their resource allocation due to these diseases. “

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