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

ISARIC Characterization Group

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1514-1530
Number of pages17
JournalKidney International Reports
Volume8
Issue number8
Early online date27 May 2023
DOIs
StatePublished - Aug 2023

Bibliographical note

Publisher Copyright:
© 2023 International Society of Nephrology

Funding

MW declared funding from the University of Queensland’s Research and Training Scholarship and the Digital Health CRC of Australia. NS and SS declared funding from Artificial Intelligence for Pandemics (A14PAN) at University of Queensland. MG declared funding from the University of Queensland. SS declared funding from The Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009). LM declared funding from UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z], Bill & Melinda Gates Foundation [OPP1209135]. DJ declared funding from research grants from Baxter and Fresenius Medical Care and the Australian National Health and Medical Research. All other authors declared no specific funding for this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The investigators acknowledge the support of the COVID clinical management team, AIIMS, Rishikesh, India; the dedication and hard work of the Groote Schuur Hospital Covid ICU Team, supported by the Groote Schuur nursing and University of Cape Town registrar bodies coordinated by the Division of Critical Care at the University of Cape Town; the dedication and hard work of the Norwegian SARS-CoV-2 study team; endorsement of the Irish Critical Care- Clinical Trials Group, co-ordination in Ireland by the Irish Critical Care- Clinical Trials Network at University College Dublin; Cambridge NIHR Biomedical Research Centre; the Liverpool School of Tropical Medicine and the University of Oxford; Imperial NIHR Biomedical Research Centre; and Preparedness work conducted by the Short Period Incidence Study of Severe Acute Respiratory Infection.

FundersFunder number
Artificial Intelligence for Pandemics
Australian National Health and Medical Research
Digital Health CRC
Groote Schuur Hospital Covid ICU
Irish Critical Care- Clinical Trials Group
Bill and Melinda Gates FoundationOPP1209135
Baxter International
Wellcome Trust215091/Z/18/Z
Manchester Biomedical Research Centre
Fresenius Medical Care North America
Australian Research CouncilCE170100009
University of Queensland
University of Cape Town
Foreign, Commonwealth and Development Office

    Keywords

    • COVID-19
    • acute kidney injury
    • community-acquired AKI
    • country income
    • dialysis
    • in-hospital death

    Fingerprint

    Dive into the research topics of 'Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19'. Together they form a unique fingerprint.

    Cite this