COVID-19 associated acute kidney injury in the second wave of pandemic in India: A single-center retrospective report

Abstract

Introduction: Acute kidney injury (AKI) in coronavirus disease (COVID-19) is understudied, especially after the initial pandemic wave and in South East Asian Region. Materials and Methods: This was a single-center retrospective cohort of 856 hospitalized COVID-19 cases between March 26, 2021, and June 7, 2021 in India to study the spectrum of AKI in COVID-19. The primary outcome was to analyze predictors of AKI. Other secondary outcome measured was mortality in AKI. Results: The incidence of AKI was 38.1%. The incidence of hemodialysis requirement was 3.5%. The proportion of AKI I, II, and III was 80.2%, 8.2%, and 11.6%, respectively. The mortality in AKI was statistically significantly higher than in non-AKI compared to AKI. Among the laboratory markers, the highest area under the curve (AUC) in the receiver operator curve was reached for red cell distribution width [AUC = 0.77 (0.73–0.81); P < 0.01]. The predictors for AKI calculated by multivariable logistic regression model in the cohort were obesity (hazard ratio (HR) = 3.2 (1.08–9.73); P = 0.04) and baseline European Cooperative Oncology Group (ECOG ≥ 3) (HR = 3.4 (1.77–6.69); P < 0.01). Similarly, the risk factors for developing AKI III included male sex (HR = 1.33 (1.05–1.68); P = 0.02) and ECOG ≥ 3 (HR = 1.5 [1.18–1.9]; P < 0.01). Conclusion: The incidence of AKI is high in hospitalized patients in the COVID-19 second wave. The mortality associated with AKI remains high. The comorbidity burden was not linked with AKI.