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05-03-2025 | Acute Kidney Injury | Original Article

Acute kidney injury in the pandemic years revisited: distinct patterns of staging and recovery in patients with and without COVID-19

Authors: Natália Piazzi de Faria, José Hermógenes Rocco Suassuna, Carlos Augusto Moreira de Souza, Sérgio Miranda Freire, Conrado Lysandro R. Gomes

Published in: Journal of Nephrology

Abstract

Background

Acute kidney injury (AKI) is a frequent and severe complication in COVID-19 patients, associated with poor outcomes. This study evaluates the characteristics and outcomes of AKI in COVID-19-positive versus negative patients during the pandemic in an emerging country, emphasizing differences in incidence, recovery, and healthcare resource utilization.

Methods

We conducted a retrospective cohort study including 9112 intensive care unit (ICU) patients from two major hospitals in Brazil, hospitalized between March 2020 and April 2022. Statistical analyses included logistic regression, Kaplan–Meier survival analysis, and time series analysis of AKI trends across COVID-19 waves.

Results

2333 patients (25.6%) tested positive for COVID-19. AKI incidence (79.7% vs. 52.6%, p < 0.001) and severity (Stage 3: 48.6% vs. 26.6%, p < 0.001) were significantly higher in the COVID-19-positive group. COVID-19 patients with AKI had longer ICU stays (median 11 vs. four days, p < 0.001) and higher mechanical ventilation needs (57.9% vs. 31.1%, p < 0.001). COVID-19 independently increased the risk of AKI (OR 2.03, CI 1.77–2.32); the coexistence of COVID-19 and AKI conferred significantly higher odds for mortality (OR 8.53, CI 6.67–11.02). Kidney recovery was less frequent in COVID-19 patients, with a higher incidence of acute kidney disease in survivors (OR 1.99, CI 1.74–2.28). Sensitivity analysis of septic patients confirmed higher AKI incidence and mortality in COVID-19 patients.

Conclusion

COVID-19 significantly affects AKI incidence, severity, and recovery, particularly in resource-limited settings. These findings emphasize the need for targeted strategies to manage kidney complications during pandemics and stress the importance of healthcare system preparedness in emerging countries.

Graphical abstract

Available only for authorised users

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Title: Acute kidney injury in the pandemic years revisited: distinct patterns of staging and recovery in patients with and without COVID-19
Authors: Natália Piazzi de Faria
José Hermógenes Rocco Suassuna
Carlos Augusto Moreira de Souza
Sérgio Miranda Freire
Conrado Lysandro R. Gomes
Publication date: 05-03-2025
Publisher: Springer International Publishing
Keywords: Acute Kidney Injury
Acute Kidney Injury
COVID-19
Published in: Journal of Nephrology
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-024-02180-7

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