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Decline in Kidney Function Faster After COVID-19-Related AKI

THURSDAY, March 11, 2021 -- For patients with in-hospital acute kidney injury (AKI), those with COVID-19-associated AKI have a greater rate of decrease in the estimated glomerular filtration rate (eGFR) after discharge, according to a study published online March 10 in JAMA Network Open.

James Nugent, M.D., M.P.H., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues conducted a retrospective cohort study at five hospitals from March 10 to Aug. 31, 2020. The rate of change in eGFR after hospital discharge was compared for patients with and without COVID-19 who experienced in-hospital AKI (182 and 1,430 patients, respectively).

The researchers found that compared with those without COVID-19, patients with COVID-19-associated AKI were more likely to be Black (40.1 versus 15.7 percent) or Hispanic (22 versus 8.8 percent) and had fewer comorbidities, but they had similar rates of preexisting chronic kidney disease and hypertension. In the unadjusted model and after adjustment for baseline comorbidities, patients with COVID-19-associated AKI had a greater decrease in eGFR (−11.3 and −12.4 mL/min/1.73 m2, respectively). After controlling for comorbidities, peak creatinine level, and in-hospital dialysis requirement, in the fully adjusted model, the eGFR slope difference persisted (−14.0 mL/min/1.73 m2). COVID-19-associated AKI was associated with reduced kidney recovery during outpatient follow-up in the subgroup of patients who had not achieved AKI recovery by discharge (adjusted hazard ratio, 0.57).

"A better understanding of COVID-19-associated AKI should provide opportunities for clinical trials to improve outcomes and inform the guidelines of post-COVID-19-associated AKI outpatient management," the authors write.

One author disclosed financial ties to Efference LLC, a medical communications company; a second author reported owning a patent for System And Methods for Diagnosing Acute Interstitial Nephritis.

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