Impact of Kidney Damage on the Course and Prognosis of COVID-19 Infection According to the International Registry «Analysis of Chronic Non-Infectious Diseases Dynamics After Covid-19 Infection in Adult Patients»

Objective. To study the course of the new coronavirus infection in patients with chronic kidney disease (CKD), to identify cases of acute kidney injury (AKI) in the setting of COVID-19 infection, and to access the impact of renal function on prognosis in these categories of patients during the acute phase and after hospitalization, at 3, 6, and 12 months after recovery. Materials and methods. The ACTIV and ACTIV 2 registries included men and women older than 18 years with a diagnosis of COVID-19 based on a positive PCR test for COVID-19 and a characteristic chest X-ray or computed tomography chest scan. Results. A total of 9364 patients (4404 men, average age59 [48-69]) were included in the analysis. 716 (7.67 %) patients had CKD. 8496 (90,7 %) patients had their glomerular filtration rate (GFR) measured during hospitalization, and the values were distributed as follows: ≥90 ml/min/1.73m² – in 4289 (50,5 %) patients, 89-60 ml/min/1.73m² — in 3150 (37,1 %) patients, 59-45 ml/min/1.73m² — in 613 (7,22 %), 44-30 ml/min/1.73m² — in 253 (2,98 %), 29-15 ml/min/1.73m² — in 110 (1,29 %), <15 ml/min/1.73m² — in 81 (0,95 %) patients. 11.6 % of the subjects (n=1068) developed AKI during hospitalization. This complication was reported more often than cytokine storm (in 7.46 % in 687 patients, р<0,001) or sepsis (in 0.17 % in 16 patients, p=620). CKD increased the risk of death by 3.94-fold in patients with COVID-19 during hospitalization compared with patients without CKD. The mortality of patients with AKI during hospitalization was 3.94 times higher than the mortality of those without AKI. CKD also affected long-term survival after hospitalization: within 3 months of follow-up, the risk of death in patients with CKD increased 4.88-fold, within 6 months — 4.24-fold, after 12 months – 8.36-fold. Conclusion. The prevalence of CKD in COVID-19 patients is similar to that in the general population. AKI developed in 11.6 % of cases with COVID-19 infection and was observed more frequently in patients with overweight and hyperglycemia. CKD and AKI increased the risk of hospital mortality in patients with COVID-19. In the group of patients with CKD, mortality increased in the post-COVID period, 3, 6 and 12 months after. The high mortality rate of patients who had AKI during the coronavirus infection was observed only in the first 3 months of follow-up in the post-COVID period.

1. Arutyunov A.G., Seferovic P., Bakulin I.G., et al. Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology. Russian Journal of Cardiology. 2021;26(9):4694. [In Russian]. https://doi.org/10.15829/1560-4071-2021-4694

2. Dobronravov V.A., Vatazin A.V., Smirnov A.V., et al. Renal service during the COVID-19 pandemic (Association of nephrologists position statement). Nephrology (Saint-Petersburg). 2021;25(1):9-17. [In Russian]. https://doi.org/10.36485/1561-6274-2021-25-1-9-17

3. Kant S., Menez S.P., Hanouneh M. et al. The COVID-19 nephrology compendium: AKI, CKD, ESKD and transplantation. BMC Nephrology. 2020; 21(1): 449. doi: 10.1186/s12882-020-02112-0.

4. Nadim M.K., Forni L.G., Mehta R.L. et al. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrology. 2020; 16(12):747-764. doi: 10.1038/s41581-020-00356-5.

5. Gromova G.G., Verizhnikova L.N., Zhbnova N.V., et al. Kidney damage in the newcoronavirus disease covid-19. Clinical nephrology. 2021; 3: 17-22. [In Russian]. doi: 10.18565/nephrology.2021.3.17-22

6. Ng J.H., Hirsch J.S., Hazzan A. et al. Northwell Nephrology COVID-19 Research Consortium. Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury. American Journal of Kidney Disease. 2021; 77(2): 204-215. doi: 10.1053/j.ajkd.2020.09.002.

7. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., et al. International register “Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients (ACTIV SARS-CoV-2)”. Kardiologiia. 2020; 60(11): 30-34. [In Russian]. https://doi.org/10.18087/cardio.2020.11.n1398

8. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., et al. International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of predictors of short-term adverse outcomes in COVID-19. Russian Journal of Cardiology. 2021; 26(4): 4470. [In Russian]. https://doi.org/10.15829/1560-4071-2021-4470

9. Tarlovskaya E.I., Arutyunov A.G., Konradi A.O., et al. Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2»). Kardiologiia. 2021;61(9):20-32. [In Russian]. https://doi.org/10.18087/cardio.2021.9.n1680

10. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., et al. International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV) and the register “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2). Russian Journal of Cardiology. 2021; 26(3): 4358. [In Russian]. https://doi.org/10.15829/1560-4071-2021-4358

11. Batiushin M.M., Gavrilov D.V., Gusev A.V., et al. The prevalence of chronic kidney disease according to the retrospective cohort study “Epidemiology of CKD” (Kirov). Nephrology and dialysis. 2021; 23(2): 192-203. [In Russian]. doi: 10.28996/2618-9801-2021-2-192-202/

12. KDIGO Clinical Practice Guideline for Acute Kidney Injury Kidney International supplements Volume 2/issue 1/ March 2012 http://www.kidney-international.org

13. Shilov E.M., Kotenko O.N., Shilova M.M., et al. Epidemiology of COVID-19 in patients receiving renal replacement therapy in the Russian Federation: results of 2020. Clinical Nephrology. 2021; 13(1): 5-12. [In Russian]. doi: 10.18565/nephrology.2021.1.5-12.