Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study using the ISARIC-WHO clinical characterisation protocol

• Published in: PLoS medicine 2022-04, Vol.19 (4), p.e1003969-e1003969
• Main Authors: Wainstein, Marina, MacDonald, Samual, Fryer, Daniel, Young, Kyle, Balan, Valeria, Begum, Husna, Burrell, Aidan, Citarella, Barbara Wanjiru, Cobb, J Perren, Kelly, Sadie, Kennon, Kalynn, Lee, James, Merson, Laura, Murthy, Srinivas, Nichol, Alistair, Semple, Malcolm G, Strudwick, Samantha, Webb, Steven A, Rossignol, Patrick, Claure-Del Granado, Rolando, Shrapnel, Sally
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Acute renal failure; Biology and Life Sciences; Cardiology and cardiovascular system; Consent; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; Creatinine; Data collection; Death; Development and progression; Diagnosis; Dialysis; Feasibility studies; Female; Hospital Mortality; Human health and pathology; Humans; Infections; Intensive Care Units; Kidney - physiology; Kidney diseases; Kidneys; Laboratories; Life Sciences; Male; Mechanical ventilation; Medicine and Health Sciences; Mortality; Pandemics; Patient outcomes; Patients; Renal function; Retrospective Studies; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Ventilation; Ventilators; World Health Organization
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1003969

Acute kidney injury (AKI) is one of the most common and significant problems in patients with Coronavirus Disease 2019 (COVID-19). However, little is known about the incidence and impact of AKI occurring in the community or early in the hospital admission. The traditional Kidney Disease Improving Global Outcomes (KDIGO) definition can fail to identify patients for whom hospitalisation coincides with recovery of AKI as manifested by a decrease in serum creatinine (sCr). We hypothesised that an extended KDIGO (eKDIGO) definition, adapted from the International Society of Nephrology (ISN) 0by25 studies, would identify more cases of AKI in patients with COVID-19 and that these may correspond to community-acquired AKI (CA-AKI) with similarly poor outcomes as previously reported in this population. All individuals recruited using the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC)-World Health Organization (WHO) Clinical Characterisation Protocol (CCP) and admitted to 1,609 hospitals in 54 countries with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection from February 15, 2020 to February 1, 2021 were included in the study. Data were collected and analysed for the duration of a patient's admission. Incidence, staging, and timing of AKI were evaluated using a traditional and eKDIGO definition, which incorporated a commensurate decrease in sCr. Patients within eKDIGO diagnosed with AKI by a decrease in sCr were labelled as deKDIGO. Clinical characteristics and outcomes-intensive care unit (ICU) admission, invasive mechanical ventilation, and in-hospital death-were compared for all 3 groups of patients. The relationship between eKDIGO AKI and in-hospital death was assessed using survival curves and logistic regression, adjusting for disease severity and AKI susceptibility. A total of 75,670 patients were included in the final analysis cohort. Median length of admission was 12 days (interquartile range [IQR] 7, 20). There were twice as many patients with AKI identified by eKDIGO than KDIGO (31.7% versus 16.8%). Those in the eKDIGO group had a greater proportion of stage 1 AKI (58% versus 36% in KDIGO patients). Peak AKI occurred early in the admission more frequently among eKDIGO than KDIGO patients. Compared to those without AKI, patients in the eKDIGO group had worse renal function on admission, more in-hospital complications, higher rates of ICU admission (54% versus 23%) invasive ventilation (45% versus 15%),