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

doi:10.1016/j.ekir.2023.05.015

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

Bar-Ilan University - Azrieli Faculty of Medicine

Research output: Contribution to journal › Article › peer-review

6 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 language	English
Pages (from-to)	1514-1530
Number of pages	17
Journal	Kidney International Reports
Volume	8
Issue number	8
Early online date	27 May 2023
DOIs	https://doi.org/10.1016/j.ekir.2023.05.015
State	Published - 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.

Funders	Funder 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 Foundation	OPP1209135
Baxter International
Wellcome Trust	215091/Z/18/Z
Manchester Biomedical Research Centre
Fresenius Medical Care North America
Australian Research Council	CE170100009
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

Access to Document

10.1016/j.ekir.2023.05.015

Cite this

@article{284f6be2b7764822b7eb1797dcd5344c,

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

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.",

keywords = "COVID-19, acute kidney injury, community-acquired AKI, country income, dialysis, in-hospital death",

author = "{ISARIC Characterization Group} and Marina Wainstein and Nicholas Spyrison and Danyang Dai and Moji Ghadimi and Ch{\'a}vez-I{\~n}iguez, {Jonathan S.} and Lilia Rizo-Topete and Citarella, {Barbara Wanjiru} and Laura Merson and Pole, {Jason D.} and {Claure-Del Granado}, Rolando and Johnson, {David W.} and Sally Shrapnel and Abdukahil, {heryl Ann} and Abdulkadir, {Nurul Najmee} and Ryuzo Abe and Laurent Abel and Amal Abrous and Lara Absil and Andrew Acker and Shingo Adachi and Diana Adri{\~a}o and {Al Ageel}, Saleh and Shakeel Ahmed and Kate Ainscough and Eka Airlangga and Tharwat Aisa and Hssain, {Ali Ait} and Tamlihat, {Younes Ait} and Takako Akimoto and Ernita Akmal and Chika Akwani and {Al Qasim}, Eman and Razi Alalqam and Angela Alberti and Tala Al-dabbous and Senthilkumar Alegesan and Marta Alessi and Beatrice Alex and K{\'e}vin Alexandre and Abdulrahman Al-Fares and Huda Alfoudri and Imran Ali and Alidjnou, {Kazali Enagnon} and Jeffrey Aliudin and Qabas Alkhafajee and Clotilde Allavena and Nathalie Allou and Jo{\~a}o Alves and Daniel Glikman and Hiba Zayyad",

note = "Publisher Copyright: {\textcopyright} 2023 International Society of Nephrology",

year = "2023",

month = aug,

doi = "10.1016/j.ekir.2023.05.015",

language = "אנגלית",

volume = "8",

pages = "1514--1530",

journal = "Kidney International Reports",

issn = "2468-0249",

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T1 - Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

AU - ISARIC Characterization Group

AU - Wainstein, Marina

AU - Spyrison, Nicholas

AU - Dai, Danyang

AU - Ghadimi, Moji

AU - Chávez-Iñiguez, Jonathan S.

AU - Rizo-Topete, Lilia

AU - Citarella, Barbara Wanjiru

AU - Merson, Laura

AU - Pole, Jason D.

AU - Claure-Del Granado, Rolando

AU - Johnson, David W.

AU - Shrapnel, Sally

AU - Abdukahil, heryl Ann

AU - Abdulkadir, Nurul Najmee

AU - Abe, Ryuzo

AU - Abel, Laurent

AU - Abrous, Amal

AU - Absil, Lara

AU - Acker, Andrew

AU - Adachi, Shingo

AU - Adrião, Diana

AU - Al Ageel, Saleh

AU - Ahmed, Shakeel

AU - Ainscough, Kate

AU - Airlangga, Eka

AU - Aisa, Tharwat

AU - Hssain, Ali Ait

AU - Tamlihat, Younes Ait

AU - Akimoto, Takako

AU - Akmal, Ernita

AU - Akwani, Chika

AU - Al Qasim, Eman

AU - Alalqam, Razi

AU - Alberti, Angela

AU - Al-dabbous, Tala

AU - Alegesan, Senthilkumar

AU - Alessi, Marta

AU - Alex, Beatrice

AU - Alexandre, Kévin

AU - Al-Fares, Abdulrahman

AU - Alfoudri, Huda

AU - Ali, Imran

AU - Alidjnou, Kazali Enagnon

AU - Aliudin, Jeffrey

AU - Alkhafajee, Qabas

AU - Allavena, Clotilde

AU - Allou, Nathalie

AU - Alves, João

AU - Glikman, Daniel

AU - Zayyad, Hiba

PY - 2023/8

Y1 - 2023/8

N2 - 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.

AB - 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.

KW - COVID-19

KW - acute kidney injury

KW - community-acquired AKI

KW - country income

KW - dialysis

KW - in-hospital death

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AN - SCOPUS:85165881923

SN - 2468-0249

VL - 8

SP - 1514

EP - 1530

JO - Kidney International Reports

JF - Kidney International Reports

IS - 8

ER -

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

Abstract

Bibliographical note

Funding

Keywords

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