11 Mar COVID-Associated Kidney Disease Has More Rapid Decline in Renal Function

MedicalResearch.com Interview with:
Jim Nugent, MD MPH
Pediatric Nephrology Fellow
Yale University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: It is now well-established that acute kidney injury is common in patients hospitalized with COVID-19. In addition, patients with COVID-19 tend to have more severe acute kidney injury than patients who have acute kidney injury due to other causes. However, the intermediate and longer-term kidney outcomes after COVID-19-associated acute kidney injury have not yet been described. Our study compares the rate of change in estimated glomerular filtration rate after hospital discharge between patients with and without COVID-19 who experienced in-hospital acute kidney injury. Due to their more severe acute kidney injury in the hospital, we hypothesized that patients with COVID-19-associated acute kidney injury would have greater decline in kidney function after discharge compared to patients with acute kidney injury who tested negative for COVID-19. In order to answer this question, we reviewed the medical records of adult patients at 5 hospitals in Connecticut and Rhode Island admitted between March and August 2020 who had developed acute kidney injury during their hospitalization, survived until discharge, and were discharged off dialysis. For our study, we included patients who had at least one outpatient serum creatinine measurement after discharge.

MedicalResearch.com: What are the main findings? 

Response: We found that patients with COVID-19-associated acute kidney injury had a more rapid decline in kidney function after discharge compared to patients without COVID-19 who had acute kidney injury. This finding persisted even after controlling for patients’ baseline comorbidities and the severity of their acute kidney injury during their hospitalization.

Our results suggest that COVID-19-associated acute kidney injury displays not only unique clinical and pathologic features, but also distinct sequelae from other causes of acute kidney injury.

MedicalResearch.com: What should readers take away from your report?

Response: Clinical practice guidelines recommend monitoring serum creatinine level within 3 months of discharge after acute kidney injury. Our findings reinforce the importance of early outpatient follow-up for patients with COVID-19 who had acute kidney injury during their hospitalization.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Our study’s findings warrant confirmation in other cohorts as well as longer observation periods to determine if this rate of decline in glomerular filtration rate persists for longer time periods. Identifying predictors of future kidney function decline for patients with COVID-19-associated acute kidney injury may also help determine which patients require the closest monitoring after discharge. The mechanism of this accelerated decline in kidney function after COVID-19-associated acute kidney injury requires further investigation, as the effect was still observed after adjusting for known risk factors for chronic kidney disease progression. In addition, it remains to be determined if this kidney function trajectory after discharge can be modified by supportive measures like avoiding nephrotoxins and optimizing blood pressure control.

MedicalResearch.com: Is there anything else you would like to add? 

Response: One limitation of the study is that we only included patients who had outpatient creatinine measurements after discharge, which may introduce selection bias such that patients at higher risk for kidney function decline are more likely to have their creatinine measured. We performed several additional modeling techniques to determine if our results were sensitive to the fact that we only included patients who had creatinine measured after discharge and our results remained consistent across all the analyses. Nevertheless, the results are observational and warrant replication in other cohorts.

Citation:

Nugent J, Aklilu A, Yamamoto Y, et al. Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19. JAMA Netw Open. 2021;4(3):e211095. doi:10.1001/jamanetworkopen.2021.1095

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Last Updated on March 11, 2021 by Marie Benz MD FAAD