LONG-TERM KIDNEY OUTCOMES OF CRITICALLY ILL PATIENTS WITH COVID-19-ASSOCIATED ACUTE KIDNEY INJURY
Dr Emily See1, Dr Anis Chaba2, A/Prof Shilpa Jesudason3, Prof Kevan Polkinghorne2,4, Prof Rinaldo Bellomo5, Prof Neil Boudville6
1Royal Melbourne Hospital, Parkville, Australia, 2Monash University, Clayton, Australia, 3Royal Adelaide Hospital, Adelaide, Australia, 4Monash Health, Clayton, Australia, 5Austin Health, Heidelberg, Australia, 6Sir Charles Gairdner Hospital, Nedlands, Australia
Aim: To assess the risk of new or progressive CKD in COVID-19 patients with acute kidney injury (AKI) and the prevalence of proteinuria screening in this population.
Background: AKI occurs commonly in COVID-19 patients admitted to intensive care units (ICUs) and is associated with several long-term complications, including chronic kidney disease (CKD).
Methods: We conducted a prospective observational cohort study of adult COVID-19 patients from 16 ICUs across Australia. Patients with pre-existing kidney failure were excluded. AKI was diagnosed using the KDIGO criteria. CKD was defined as a sustained eGFR <60 mL/min/1.73m2 for ≥3 months and progressive CKD as a decline in KDIGO eGFR category accompanied by a ≥25% drop in eGFR from baseline. Multivariable logistic regression analyses were performed to evaluate the relationship between AKI and new or progressive CKD at 12 months. Proteinuria screening and its association with new or progressive CKD were also examined.
Results: Of 2890 patients, 879 (31%) developed AKI. AKI was strongly associated with new or progressive CKD (34% vs. 6%, p<0.001, OR = 7.17, 95%CI 5.52 to 9.38). Even among those with AKI recovery by ICU discharge, a significantly higher risk of CKD was noted (OR = 2.96, 95%CI 2.12 to 4.11). Proteinuria screening was only performed in 24% of AKI patients, yet its presence was associated with a significantly increased risk of subsequent CKD (OR = 2.86, 95% CI [1.25 to 6.87]).
Conclusions: AKI is a common complication among critically ill COVID-19 patients and a significant predictor of long-term kidney impairment. These findings underscore the importance of vigilant monitoring for CKD following AKI and suggest that routine proteinuria screening may help identify patients at elevated risk.
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Biography:
Dr Emily See is a Consultant Intensivist and Nephrologist at the Royal Melbourne Hospital, a Senior Honorary Fellow at the University of Melbourne, and an Adjunct Senior Research Fellow at Monash University. She holds a Master of Medical Statistics degree from the University of Oxford and a PhD in Clinical Medicine from the University of Melbourne. Her clinical and research interests centre around acute kidney injury, continuous renal replacement therapy, and sepsis.