Renal injury from COVID-19 ‘increases risk of death’ up to a year post-infection

Severe COVID-19, advanced age and ischaemic heart disease are also linked to worse mortality outcomes, global study shows
Staff writer

Patients with acute kidney injury as a result of COVID-19 are up to four times more likely to die from any cause 12 months post-infection than those without the complication, a major international study reveals.

While acute kidney injury (AKI) is common in those with SARS-CoV-2 infection, the findings highlight the need to explore ways to reduce progression to chronic kidney disease, say the Singapore-led authors.

The retrospective observational study, published in eClinicalMedicine, involved nearly 12,000 hospitalised adults with lab-confirmed infection across five countries between January and September 2020.

All patients underwent kidney function testing in the year prior to admission, which provided baseline data; mortality and serum creatinine values were obtained during a median 430-day follow-up.

Half of the cohort (51%) had at least one episode of AKI during their hospitalisation, and 22% died.

Overall, those with severe AKI — defined as Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 — had a fourfold higher risk of death than those without AKI, the authors found.

Patients with AKI of any severity had higher mortality in the follow-up period than those without this complication (33% vs 10%).


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Severe COVID-19, advanced age (over 70) and ischaemic heart disease were also associated with worse mortality outcomes.

“With respect to medications, we did not observe any mortality benefit of anticoagulant use in COVID-19 patients with AKI, which is in line with randomised controlled trials that did not observe any mortality differences with therapeutic anticoagulant dosing over prophylactic dosing,” the researchers wrote.

Similar negative associations were seen for post-AKI renal function impairment, with male sex also linked to poorer outcomes during recovery.

Patients with AKI had a 49% increased risk of significant elevations of baseline serum creatinine (125% or more) at six months and a 54% increased risk at one year, compared with patients without COVID-19-associated AKI.

Furthermore, treatment with the antiviral remdesivir was linked with significantly better kidney function recovery in a subset of 1800 patients.

“Further studies are warranted to identify therapeutic strategies to delay the onset and/or progression into chronic kidney disease after an inciting AKI event,” the authors concluded.

But they stressed the study comprised unvaccinated individuals, so it was unclear how COVID-19 vaccination may alter long-term kidney function recovery after infection.


More information: eClinicalMedicine 2022; 7 Nov.