Authors: Marina Wainstein, Ayodhia Pitaloka Pasaribu, 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, David W. Johnson, Sally Shrapnel and on behalf of the ISARIC Characterization Group

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.

Keywords: COVID-19; acute kidney injury; community-acquired AKI; country income; dialysis; in-hospital death.

DOI: 10.1016/j.ekir.2023.05.015

Published: 27 May 2023