Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

ISARIC Characterization Group; Marina Wainstein; Nicholas Spyrison; Danyang Dai; Moji Ghadimi; Jonathan S. Chávez-Iñiguez; Lilia Rizo-Topete; Barbara Wanjiru Citarella; Laura Merson; Jason D. Pole; Rolando Claure-Del Granado; David W. Johnson; Sally Shrapnel

doi:10.1016/j.ekir.2023.05.015

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

ISARIC Characterization Group, Marina Wainstein^*, Nicholas Spyrison, Danyang Dai, Moji Ghadimi, Jonathan S. Chávez-Iñiguez, Lilia Rizo-Topete, Barbara Wanjiru Citarella, Laura Merson, Jason D. Pole, Rolando Claure-Del Granado, David W. Johnson, Sally Shrapnel^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	1514-1530
Number of pages	17
Journal	Kidney International Reports
Volume	8
Issue number	8
Early online date	27 May 2023
DOIs	https://doi.org/10.1016/j.ekir.2023.05.015
Publication status	Published - Aug 2023

Bibliographical note

Funding:
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.

Keywords

acute kidney injury
community-acquired AKI
country income
COVID-19
dialysis
in-hospital death

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ISARIC Characterization Group, Wainstein, M., Spyrison, N., Dai, D., Ghadimi, M., Chávez-Iñiguez, J. S., Rizo-Topete, L., Citarella, B. W., Merson, L., Pole, J. D., Granado, R. C.-D., Johnson, D. W., & Shrapnel, S. (2023). Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19. Kidney International Reports, 8(8), 1514-1530. https://doi.org/10.1016/j.ekir.2023.05.015

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title = "Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19",

abstract = "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.",

keywords = "acute kidney injury, community-acquired AKI, country income, COVID-19, dialysis, in-hospital death",

author = "{ISARIC Characterization Group} and Marina Wainstein and Nicholas Spyrison and Danyang Dai and Moji Ghadimi and Ch{\'a}vez-I{\~n}iguez, {Jonathan S.} and Lilia Rizo-Topete and Citarella, {Barbara Wanjiru} and Laura Merson and Pole, {Jason D.} and Granado, {Rolando Claure-Del} and Johnson, {David W.} and Sally Shrapnel and Christopher Green",

note = "Funding: MW declared funding from the University of Queensland{\textquoteright}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.",

year = "2023",

month = aug,

doi = "10.1016/j.ekir.2023.05.015",

language = "English",

volume = "8",

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journal = "Kidney International Reports",

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ISARIC Characterization Group, Wainstein, M, Spyrison, N, Dai, D, Ghadimi, M, Chávez-Iñiguez, JS, Rizo-Topete, L, Citarella, BW, Merson, L, Pole, JD, Granado, RC-D, Johnson, DW & Shrapnel, S 2023, 'Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19', Kidney International Reports, vol. 8, no. 8, pp. 1514-1530. https://doi.org/10.1016/j.ekir.2023.05.015

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19. / ISARIC Characterization Group; Wainstein, Marina; Spyrison, Nicholas et al.
In: Kidney International Reports, Vol. 8, No. 8, 08.2023, p. 1514-1530.

Research output: Contribution to journal › Article › peer-review

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 - Granado, Rolando Claure-Del

AU - Johnson, David W.

AU - Shrapnel, Sally

AU - Green, Christopher

N1 - Funding: 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.

PY - 2023/8

Y1 - 2023/8

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

U2 - 10.1016/j.ekir.2023.05.015

DO - 10.1016/j.ekir.2023.05.015

M3 - Article

SN - 2468-0249

VL - 8

SP - 1514

EP - 1530

JO - Kidney International Reports

JF - Kidney International Reports

IS - 8

ER -

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Abstract

Bibliographical note

Keywords

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