Long-term outcomes after AKI in hospitalized patients with COVID-19
Introduction and objectives: Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19. Mater...
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| Language: | Spanish |
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Elsevier
2025-02-01
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| Series: | Nefrología |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0211699524000808 |
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| author | Bernardo Marques da Silva Joana Gameiro Joana Lei Teixeira Cláudia Costa Carolina Branco João Oliveira João Bernardo Filipe Marques José Agapito Fonseca José António Lopes |
| author_facet | Bernardo Marques da Silva Joana Gameiro Joana Lei Teixeira Cláudia Costa Carolina Branco João Oliveira João Bernardo Filipe Marques José Agapito Fonseca José António Lopes |
| author_sort | Bernardo Marques da Silva |
| collection | DOAJ |
| description | Introduction and objectives: Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19. Material and methods: Single-center and retrospective study of hospitalized patients admitted to a Dedicated Unit for COVID-19 at Centro Hospitalar Universitário Lisboa Norte, Portugal, between March 2020 and October 2020. AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, using SCr criteria. The analyzed outcomes were development of major adverse kidney events (MAKE), major adverse renal cardiovascular events (MARCE), and mortality over a two-year follow-up period. Results: From the included 409 patients, AKI occurred in 60.4% (n = 247). Within two years after discharge, 31.8% (n = 130) of patients had an eGFR < 60 mL/min/1.73 m2 and/or a 25% decrease on eGFR and 1.7% (n = 7) of patients required RRT, 6.1% (n = 25) of patients had CV events and 27.9% (n = 114) of patients died. The incidence of MAKE was 60.9% (n = 249), and MARCE was 62.6% (n = 256). On a multivariate analysis, older age (adjusted HR 1.02 (95% CI: 1.01–1.04), p = 0.008), cardiovascular disease (adjusted HR 2.22 (95% CI: 1.24–3.95), p = 0.007), chronic kidney disease (adjusted HR 5.15 (95% CI: 2.22–11.93), p < 0.001), and AKI (adjusted HR 1.76 (95% CI: 1.12–2.78), p = 0.015) were independent predictors of MAKE. Older age (adjusted HR 1.06 (95% CI: 1.04–1.08), p < 0.001) and neoplasia (adjusted HR 4.88 (95% CI: 2.37–10.04), p < 0.001) were independent predictors of mortality. Conclusions: In this cohort of hospitalized patients with COVID-19, AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and/or mortality after hospital discharge. Resumen: Introducción y objetivos: La insuficiencia renal aguda (IRA) es frecuente en los pacientes hospitalizados, y contribuye a resultados adversos a corto y a largo plazo. Nuestro objetivo fue evaluar la asociación entre la IRA y los episodios renales adversos a largo plazo y la mortalidad en una cohorte de pacientes hospitalizados con COVID-19. Material y métodos: Estudio unicéntrico y retrospectivo de pacientes hospitalizados ingresados en una unidad especializada en COVID-19 en el Centro Hospitalar Universitário Lisboa Norte, Portugal, entre marzo y octubre de 2020. La IRA se definió y clasificó de acuerdo con la escala Kidney Disease: Improving Global Outcomes (KDIGO) utilizando los criterios SCr. Los resultados analizados fueron el desarrollo de episodios Major Adverse Kidney Events (MAKE), Major Adverse Renal Cardiovascular Events (MARCE) y la mortalidad a lo largo de un periodo de seguimiento de dos años. Resultados: En los 409 pacientes incluidos, se produjo IRA en el 60,4% (n = 247) de ellos. En un periodo de dos años desde la recepción del alta, el 31,8% (n = 130) de los pacientes tuvo un índice eGFR < 60 ml/min/1,73 m2 y/o una reducción de dicho eGFR del 25%, requiriendo TRR el 1,7% (n = 7) de los pacientes. El 6,1% (n = 25) de los pacientes tuvieron episodios CV, falleciendo el 27,9% (n = 114) de los mismos. La incidencia de MAKE fue del 60,9% (n = 249), y la de MARCE, del 62,6% (n = 256). En un análisis multivariante, la edad avanzada (HR ajustado 1,02 [IC 95%: 1,01-1,04], p = 0,008), la enfermedad cardiovascular (HR ajustado 2,22 [IC 95%: 1,24-3,95], p = 0,007), la enfermedad renal crónica (HR ajustado 5,15 [IC 95%: 2,22-11,93], p < 0,001) y la IRA (HR ajustado 1,76 [IC 95%: 1,12-2,78], p = 0,015) fueron factores predictivos independientes de MAKE. La edad avanzada (HR ajustado 1,06 [IC 95%: 1,04-1,08], p < 0,001) y la neoplasia (HR ajustado 4,88 [IC 95%: 2,37-10,04], p < 0,001) fueron factores predictivos independientes de la mortalidad. Conclusiones: En esta cohorte de pacientes hospitalizados con COVID-19, la IRA estuvo asociada de manera independiente al riesgo de necesidad de diálisis a largo plazo y/o a la reducción de la función renal y/o mortalidad tras el alta hospitalaria. |
| format | Article |
| id | doaj-art-95105e6965fd4402a01e8d4bc0eae9bf |
| institution | Kabale University |
| issn | 0211-6995 |
| language | Spanish |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Nefrología |
| spelling | doaj-art-95105e6965fd4402a01e8d4bc0eae9bf2025-01-26T05:03:17ZspaElsevierNefrología0211-69952025-02-01452150158Long-term outcomes after AKI in hospitalized patients with COVID-19Bernardo Marques da Silva0Joana Gameiro1Joana Lei Teixeira2Cláudia Costa3Carolina Branco4João Oliveira5João Bernardo6Filipe Marques7José Agapito Fonseca8José António Lopes9Clínica Universitária de Nefrologia, Faculdade de Medicina da Universidade de Lisboa, Spain; Serviço de Nefrologia e Transplantação Renal, ULS Santa Maria, Spain; Corresponding author.Clínica Universitária de Nefrologia, Faculdade de Medicina da Universidade de Lisboa, Spain; Serviço de Nefrologia e Transplantação Renal, ULS Santa Maria, SpainClínica Universitária de Nefrologia, Faculdade de Medicina da Universidade de Lisboa, SpainClínica Universitária de Nefrologia, Faculdade de Medicina da Universidade de Lisboa, Spain; Serviço de Nefrologia e Transplantação Renal, ULS Santa Maria, SpainClínica Universitária de Nefrologia, Faculdade de Medicina da Universidade de Lisboa, Spain; Serviço de Nefrologia e Transplantação Renal, ULS Santa Maria, SpainServiço de Nefrologia e Transplantação Renal, ULS Santa Maria, SpainServiço de Nefrologia e Transplantação Renal, ULS Santa Maria, SpainClínica Universitária de Nefrologia, Faculdade de Medicina da Universidade de Lisboa, Spain; Serviço de Nefrologia e Transplantação Renal, ULS Santa Maria, SpainClínica Universitária de Nefrologia, Faculdade de Medicina da Universidade de Lisboa, Spain; Serviço de Nefrologia e Transplantação Renal, ULS Santa Maria, SpainClínica Universitária de Nefrologia, Faculdade de Medicina da Universidade de Lisboa, Spain; Serviço de Nefrologia e Transplantação Renal, ULS Santa Maria, SpainIntroduction and objectives: Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19. Material and methods: Single-center and retrospective study of hospitalized patients admitted to a Dedicated Unit for COVID-19 at Centro Hospitalar Universitário Lisboa Norte, Portugal, between March 2020 and October 2020. AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, using SCr criteria. The analyzed outcomes were development of major adverse kidney events (MAKE), major adverse renal cardiovascular events (MARCE), and mortality over a two-year follow-up period. Results: From the included 409 patients, AKI occurred in 60.4% (n = 247). Within two years after discharge, 31.8% (n = 130) of patients had an eGFR < 60 mL/min/1.73 m2 and/or a 25% decrease on eGFR and 1.7% (n = 7) of patients required RRT, 6.1% (n = 25) of patients had CV events and 27.9% (n = 114) of patients died. The incidence of MAKE was 60.9% (n = 249), and MARCE was 62.6% (n = 256). On a multivariate analysis, older age (adjusted HR 1.02 (95% CI: 1.01–1.04), p = 0.008), cardiovascular disease (adjusted HR 2.22 (95% CI: 1.24–3.95), p = 0.007), chronic kidney disease (adjusted HR 5.15 (95% CI: 2.22–11.93), p < 0.001), and AKI (adjusted HR 1.76 (95% CI: 1.12–2.78), p = 0.015) were independent predictors of MAKE. Older age (adjusted HR 1.06 (95% CI: 1.04–1.08), p < 0.001) and neoplasia (adjusted HR 4.88 (95% CI: 2.37–10.04), p < 0.001) were independent predictors of mortality. Conclusions: In this cohort of hospitalized patients with COVID-19, AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and/or mortality after hospital discharge. Resumen: Introducción y objetivos: La insuficiencia renal aguda (IRA) es frecuente en los pacientes hospitalizados, y contribuye a resultados adversos a corto y a largo plazo. Nuestro objetivo fue evaluar la asociación entre la IRA y los episodios renales adversos a largo plazo y la mortalidad en una cohorte de pacientes hospitalizados con COVID-19. Material y métodos: Estudio unicéntrico y retrospectivo de pacientes hospitalizados ingresados en una unidad especializada en COVID-19 en el Centro Hospitalar Universitário Lisboa Norte, Portugal, entre marzo y octubre de 2020. La IRA se definió y clasificó de acuerdo con la escala Kidney Disease: Improving Global Outcomes (KDIGO) utilizando los criterios SCr. Los resultados analizados fueron el desarrollo de episodios Major Adverse Kidney Events (MAKE), Major Adverse Renal Cardiovascular Events (MARCE) y la mortalidad a lo largo de un periodo de seguimiento de dos años. Resultados: En los 409 pacientes incluidos, se produjo IRA en el 60,4% (n = 247) de ellos. En un periodo de dos años desde la recepción del alta, el 31,8% (n = 130) de los pacientes tuvo un índice eGFR < 60 ml/min/1,73 m2 y/o una reducción de dicho eGFR del 25%, requiriendo TRR el 1,7% (n = 7) de los pacientes. El 6,1% (n = 25) de los pacientes tuvieron episodios CV, falleciendo el 27,9% (n = 114) de los mismos. La incidencia de MAKE fue del 60,9% (n = 249), y la de MARCE, del 62,6% (n = 256). En un análisis multivariante, la edad avanzada (HR ajustado 1,02 [IC 95%: 1,01-1,04], p = 0,008), la enfermedad cardiovascular (HR ajustado 2,22 [IC 95%: 1,24-3,95], p = 0,007), la enfermedad renal crónica (HR ajustado 5,15 [IC 95%: 2,22-11,93], p < 0,001) y la IRA (HR ajustado 1,76 [IC 95%: 1,12-2,78], p = 0,015) fueron factores predictivos independientes de MAKE. La edad avanzada (HR ajustado 1,06 [IC 95%: 1,04-1,08], p < 0,001) y la neoplasia (HR ajustado 4,88 [IC 95%: 2,37-10,04], p < 0,001) fueron factores predictivos independientes de la mortalidad. Conclusiones: En esta cohorte de pacientes hospitalizados con COVID-19, la IRA estuvo asociada de manera independiente al riesgo de necesidad de diálisis a largo plazo y/o a la reducción de la función renal y/o mortalidad tras el alta hospitalaria.http://www.sciencedirect.com/science/article/pii/S0211699524000808COVID-19Insuficiencia renal agudaResultados a largo plazoEpisodios renales adversos mayoresMortalidad |
| spellingShingle | Bernardo Marques da Silva Joana Gameiro Joana Lei Teixeira Cláudia Costa Carolina Branco João Oliveira João Bernardo Filipe Marques José Agapito Fonseca José António Lopes Long-term outcomes after AKI in hospitalized patients with COVID-19 Nefrología COVID-19 Insuficiencia renal aguda Resultados a largo plazo Episodios renales adversos mayores Mortalidad |
| title | Long-term outcomes after AKI in hospitalized patients with COVID-19 |
| title_full | Long-term outcomes after AKI in hospitalized patients with COVID-19 |
| title_fullStr | Long-term outcomes after AKI in hospitalized patients with COVID-19 |
| title_full_unstemmed | Long-term outcomes after AKI in hospitalized patients with COVID-19 |
| title_short | Long-term outcomes after AKI in hospitalized patients with COVID-19 |
| title_sort | long term outcomes after aki in hospitalized patients with covid 19 |
| topic | COVID-19 Insuficiencia renal aguda Resultados a largo plazo Episodios renales adversos mayores Mortalidad |
| url | http://www.sciencedirect.com/science/article/pii/S0211699524000808 |
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