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TOPLINE:

Survivors of COVID-19−associated acute kidney injury (COVID-AKI) are less likely to experience long-term kidney effects than those with AKI associated with influenza or other illnesses.

METHODOLOGY:

• Researchers assessed whether the long-term trajectory of kidney function differed between patients with COVID-AKI and patients with AKI caused by other illnesses, such as influenza.
• The study included 9624 patients (mean age, 69.0 years; 51.5% women; 73.8% White) who survived hospitalization with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI linked to other illnesses.
• The primary outcome was major adverse kidney events (MAKE), a composite of mortality and worsened kidney function (defined as estimated glomerular filtration rate [eGFR] decline by ≥ 25% or kidney failure requiring dialysis).
• Secondary outcomes included components of MAKE and changes in eGFR from discharge through a follow-up period of 2 years. Data on deaths were taken from electronic health records.

TAKEAWAY: 

• Patients with COVID-AKI had a 33% lower risk for MAKE (adjusted hazard ratio [aHR], 0.67; P < .001) than patients with AKI due to other illnesses.
• Patients who developed AKI during COVID hospitalization also had a 22% lower risk for worsened kidney function (aHR, 0.78; P < .001) and a 69% lower risk for mortality (aHR, 0.31; P < .001) than those with AKI associated with other illnesses.
• These results were consistent across various analyses, including propensity score matching, inverse probability weighting, and multivariable assessments that included more stringent parameters of kidney function.

IN PRACTICE:

"Those who survive a COVID-19 infection complicated by AKI may have inherent unmeasured characteristics that are associated with favorable longer-term outcomes," the authors wrote.

SOURCE:

The study, led by Abinet M. Aklilu, MD, MPH, Clinical and Translational Research Accelerator, Yale University, New Haven, Connecticut, was published online on February 26, 2024, in JAMA Internal Medicine.

LIMITATIONS:

Some unmeasured confounders may have contributed to the longitudinal trajectory of eGFR. Furthermore, the kidney function may have been affected by exposure to different renoprotective medicines during the follow-up period. In addition, adjustments were not made for social determinants of health due to lack of data.

DISCLOSURES:

The study was supported by the Agency for Healthcare Research and Quality. Some of the authors reported receiving grants, personal fees, or consulting fees, as well as having pending or issued patents from multiple sources.