Community-Acquired Acute Kidney Injury and Late Kidney Dysfunction in Survivors of COVID-19 Hospitalization

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Introduction Data on the incidence and risk factors for renal long COVID are scarce. We aimed to investigate two acute kidney injury (AKI) phenotypes – community (CA-AKI) and hospital-acquired (HA-AKI) – and the development of late kidney dysfunction in survivors of COVID-19 hospitalization. Methods This is a prospective cohort study of survivors of moderate to severe COVID-19 hospitalization in Brazil, from March to August 2020. Patients were assessed for up to 11 months after hospital discharge. Exposure was CA- and HA-AKI. Main outcome was kidney dysfunction defined as incident low estimated glomerular filtration rate (eGFR; <60 mL/min/1.73m 2 ) and/or eGFR decline ≥25% from discharge at follow-up. An adjusted binary logistic regression analysis was run. Results A total of 655 survivors were evaluated (6.5±1.9 follow-up months); 79% had AKI (35% CA and 43% HA); 14% used kidney replacement therapy. Late kidney dysfunction occurred in 28% of the patients (16% incident low eGFR and 27% eGFR decline ≥25%). CA-AKI, but not HA-AKI, was independently associated with late kidney dysfunction (adjusted odds ratio [aOR]=7.3, 95%CI: 3.6 to 15.8 and aOR=2.2, 95%CI: 0.9 to 4.8, respectively). Conclusion In conclusion, late kidney dysfunction affected one in four COVID-19 survivors. CA-AKI, but not HA-AKI, was an independent risk factor for late kidney dysfunction. These findings suggest that renal long COVID might be frequent and that a specific AKI phenotype (CA-AKI) may play a crucial role in its development. Our research highlights the need for CA-AKI prevention and for the long-term follow-up and care of patients affected by this AKI phenotype during COVID-19 infection.