Abstract：
Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI- COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed MATERIAL AND METHOD: In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality.
Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases. The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41), and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, and shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55).
Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as a risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases. The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41), and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, and shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55).
Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as a risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
摘要：
背景：急性肾损伤（AKI）在COVID-19住院患者中很常见，且预后较差。西班牙肾脏病学会创建了AKI-COVID登记处，以描述在西班牙医院发生AKI的COVID-19入院的人群。肾脏替代疗法（RRT）治疗方式的需要，对这些患者的死亡率进行了材料和方法评估：在一项回顾性研究中，我们分析了AKI-COVID登记处的数据，其中包括2020年5月至2021年11月在30家西班牙医院住院的患者。临床和人口统计学变量，与COVID-19和AKI严重程度相关的因素，并记录生存数据。进行多因素回归分析以研究与RRT和死亡率相关的因素。
结果：记录来自730名患者的数据。共有71.9%是男性,平均年龄70岁（60-78岁），70.1%是高血压,32.9%糖尿病,33.3%有心血管疾病，23.9%有一定程度的慢性肾脏病(CKD)。肺炎被诊断为94.6%，54.2%的患者需要通气支持，44.1%的患者需要进入ICU。从COVID-19症状发作到出现AKI的中位时间(37.1%KDIGOI，18.3%KDIGOII,44.6%KDIGOIII)为6天(4-10)。共有235例（33.9％）患者需要RRT：155例患者接受连续肾脏替代疗法，89隔日透析,每天透析36次，24例延长血液透析患者和17例血液透析滤过患者。吸烟习惯（OR3.41），通气支持（OR20.2），最大肌酐值（OR2.41），AKI发病时间(OR1.13)是RRT需要的预测因子;年龄是保护因素(0.95).无RRT组的特点是年龄较大，不太严重的AKI，肾损伤的发生和恢复时间较短(p<0.05)。38.6％的患者在住院期间死亡；死亡组中严重的AKI和RRT更常见。在多变量分析中，年龄（OR1.03），既往慢性肾病（OR2.21），肺炎的发展（OR2.89），通气支持(OR3.34)和RRT(OR2.28)是死亡率的预测因子,而ARBs慢性治疗被确定为保护因子(OR0.55).
结论：COVID-19住院期间AKI患者的平均年龄较高，合并症和严重感染。我们定义了两种不同的临床模式：早期发作的AKI，在不需要RRT的情况下在几天内消退的老年患者中；还有另一种更严重的模式，随着对RRT的更大需求，和迟发性，这与传染病的严重程度有关。感染的严重程度,年龄和入院前CKD的存在被确定为这些患者死亡的危险因素.此外，ARB的慢性治疗被认为是死亡的保护因素。
结果：记录来自730名患者的数据。共有71.9%是男性,平均年龄70岁（60-78岁），70.1%是高血压,32.9%糖尿病,33.3%有心血管疾病，23.9%有一定程度的慢性肾脏病(CKD)。肺炎被诊断为94.6%，54.2%的患者需要通气支持，44.1%的患者需要进入ICU。从COVID-19症状发作到出现AKI的中位时间(37.1%KDIGOI，18.3%KDIGOII,44.6%KDIGOIII)为6天(4-10)。共有235例（33.9％）患者需要RRT：155例患者接受连续肾脏替代疗法，89隔日透析,每天透析36次，24例延长血液透析患者和17例血液透析滤过患者。吸烟习惯（OR3.41），通气支持（OR20.2），最大肌酐值（OR2.41），AKI发病时间(OR1.13)是RRT需要的预测因子;年龄是保护因素(0.95).无RRT组的特点是年龄较大，不太严重的AKI，肾损伤的发生和恢复时间较短(p<0.05)。38.6％的患者在住院期间死亡；死亡组中严重的AKI和RRT更常见。在多变量分析中，年龄（OR1.03），既往慢性肾病（OR2.21），肺炎的发展（OR2.89），通气支持(OR3.34)和RRT(OR2.28)是死亡率的预测因子,而ARBs慢性治疗被确定为保护因子(OR0.55).
结论：COVID-19住院期间AKI患者的平均年龄较高，合并症和严重感染。我们定义了两种不同的临床模式：早期发作的AKI，在不需要RRT的情况下在几天内消退的老年患者中；还有另一种更严重的模式，随着对RRT的更大需求，和迟发性，这与传染病的严重程度有关。感染的严重程度,年龄和入院前CKD的存在被确定为这些患者死亡的危险因素.此外，ARB的慢性治疗被认为是死亡的保护因素。
