TY - JOUR
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 - Burhan, Erlina
AU - Juzar, Dafsah
AU - Rasmin, Menaldi
N1 - Funding Information:
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.
Funding Information:
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.
Publisher Copyright:
© 2023 International Society of Nephrology
PY - 2023
Y1 - 2023
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 - acute kidney injury
KW - community-acquired AKI
KW - country income
KW - COVID-19
KW - dialysis
KW - in-hospital death
UR - http://www.scopus.com/inward/record.url?scp=85165881923&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2023.05.015
DO - 10.1016/j.ekir.2023.05.015
M3 - Article
AN - SCOPUS:85165881923
SN - 2468-0249
VL - 8
SP - 1514
EP - 1530
JO - Kidney International Reports
JF - Kidney International Reports
IS - 8
ER -