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Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19
Journal article   Open access   Peer reviewed

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Marina Wainstein, Nicholas Spyrison, Danyang Dai, Moji Ghadimi, Jonathan S. Chávez-Iñiguez, Lilia Rizo-Topete, Barbara Wanjiru Citarella, Laura Merson, Jason D. Pole, Rolando Claure-Del Granado, …
Kidney International Reports, Vol.8(8)
2023
DOI: https://doi.org/10.1016/j.ekir.2023.05.015

Abstract

anti-SARS-CoV-2 agent antibiotic agent antifungal agent corticosteroid acute kidney failure adult aged Article bacterial pneumonia blood clotting disorder cohort analysis community controlled study coronavirus disease 2019 country economic status critically ill patient disease severity female heart arrest high income country hospital admission hospital patient hospitalization human in-hospital mortality incidence intensive care intensive care unit low income country major clinical study male middle income country observational study prospective study renal replacement therapy rhabdomyolysis treatment outcome
Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes. © 2023 International Society of Nephrology
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https://doi.org/10.1016/j.ekir.2023.05.015View
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