COVID-linked kidney injury tied to higher risk of death in hospital patients
An observational study published this week in eClinicalMedicine suggests that COVID-19–related acute kidney injury (AKI) is tied to a greater risk of death, and that severe AKI may lead to poor recovery of kidney function.
Researchers with the Consortium for Clinical Characterization of COVID-19 by EHR (electronic health record) assessed AKI and subsequent recovery among 12,891 adult patients who tested positive for COVID-19 from Jan 1 to Sep 10, 2020, and were admitted to 15 hospitals in 11 healthcare systems in 5 countries.
Participants had at least one recorded serum creatinine value in the year before hospitalization up to Sep 10, 2021. The study took place during wild-type virus dominance before the COVID-19 vaccine rollout.
Of the 12,891 COVID-19 patients, 50.5% had at least one episode of AKI. Relative to non-AKI patients, those with an AKI diagnosis had a higher death rate (32.5% vs 10.4%), and 39.2% didn't recover total kidney function within 90 days or end of follow-up.
Risk factors for death were severe AKI (hazard ratio [HR], 4.22) and ischemic heart disease (HR, 1.26). Severe AKI was tied to worse kidney recovery, while the use of the antiviral remdesivir (HR, 1.34) was associated with better recovery.
AKI patients were more likely than those without the diagnosis to be men (77.8% vs 71.2%), aged 70 years and older (55.0% vs 35.9%; HR, 2.77), and to have severe COVID-19 (58.6% vs 27.8%; HR, 2.91).
Participants diagnosed as having COVID-19-linked AKI were more likely to have chronic kidney disease (CKD; 47.8% vs 28.6%), cirrhosis (3.2% vs 2.4%), high blood pressure (59.8% vs 42.4%), ischemic heart disease (22.4% vs 12.6%), chronic obstructive pulmonary disease (COPD; 14.8% vs. 9.6%), and previous venous thromboembolism (blood clot in a vein; 20.3% vs 13.4%).
Elevated baseline serum creatinine (indicating poor kidney function) was noted in AKI patients at 6 months (risk ratio [RR], 1.49) and 1 year (RR, 1.54).
"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 wrote.
Nov 7 eClinicalMedicine study
UK study shows few COVID-19 deaths in children, young adults
A study yesterday in PLOS Medicine conducted in England shows that the risk of death due to COVID-19 remains very low for children and young adults, with most deaths occurring in those with underlying health conditions.
Researchers from the UK Health Security Agency analyzed data on anyone in England under the age of 20 who died within 100 days of a confirmed COVID-19 infection between March 2020 and December 2021.
Of 185 total deaths that occurred, 81 were due to COVID-19. Of those 81, 75% of patients had significant underlying health issues, including severe disability (27 case-patients) or compromised immune systems (12 case-patients).
Half the COVID-19 deaths (41/81, 50.6%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days, the authors said.
For the 22 months of the study, COVID-19 was responsible for 1.2% (81/6,790) of all deaths in people aged less than 20 years, with an infection fatality rate of 0.70 per 100,000 SARS-CoV-2 infections.
In a PLOS press release on the study, coauthor Shamez Ladhani, PhD, said, "Our national surveillance in England continues to show a very very low risk of death due to COVID-19 in children and teenagers, with most fatalities occurring in those with multiple and life-limiting underlying conditions."
Nov 8 PLOS Med study
Nov 8 PLOS press release