Utilization of a national database to characterize renal function in patients admitted with COVID19 infection

Abstract

Purpose Acute kidney injury (AKI) and augmented renal clearance (ARC) have been documented in patients with COVID19 but the incidence and outcomes related to drug therapy of each alteration are unknown. This study sought to determine the incidence of AKI or ARC in patients hospitalized with COVID19 and identify risk factors for each. Methods This was a retrospective, observational cohort analysis of adults within the National COVID Cohort Collaborative database hospitalized between 1 January 2020 and 9 April 2022 with laboratory confirmed COVID19 and available data to calculate creatinine clearance using the Cockcroft-Gault equation. Patients were excluded for pregnancy, BMI < 18kg/m², and history of end-stage renal disease or nephrectomy. Renal function characteristics and outcomes were analyzed using descriptive statistics and Mann-Whitney-U tests. Univariate and multivariate logistic regression were used to identify risk factors. Results 20,406 patients met inclusion criteria and 15,608 were included for analysis where 20.9% experienced AKI and 34.8% exhibited ARC. From 11,274 patients included in logistic regression analysis height and White race were associated with decreased risk of AKI while male sex and diabetes were associated with increased risk. Male sex, Black race, and hypertension were associated with decreased risk of ARC. Age was associated with decreased risk of either alteration while weight and Hispanic ethnicity increased risk. Conclusion A significant proportion of COVID19 hospitalized patients exhibit renal alterations. These results provide initial evidence of identifying patients at risk of AKI or ARC, but more research is needed, especially with respect to use of biomarkers for renal alteration risk stratification.