Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19
Marina Wainstein, Nicholas Spyrison, Danyang Dai, Moji Ghadimi, Jonathan S. Chávez-Íñiguez, Lilia Rizo‐Topete, Barbara Wanjiru Citarella, Laura Merson, Jason D. Pole, Rolando Claure-Del Granado, David W. Johnson, Sally Shrapnel, heryl Ann Abdukahil, Nurul Najmee Abdulkadir, Ryuzo Abe, Laurent Abel, Amal Abrous, Lara Absil, Andrew Acker, Shingo Adachi, Diana Adrião, Saleh Al Ageel, Shakeel Ahmed, Kate Ainscough, Eka Airlangga, Tharwat Aisa, Ali Ait Hssain, Younes Ait Tamlihat, Takako Akimoto, Ernita Akmal, Chika Akwani, Eman Al Qasim, Razi Alalqam, Angela Alberti, Tala Al-dabbous, Senthilkumar Alegesan, Marta Alessi, Beatrice Alex, Kévin Alexandre, Abdulrahman Al‐Fares, Huda Alfoudri, Imran Ali, Kazali Enagnon Alidjnou, Jeffrey Aliudin, Qabas Alkhafajee, Clotilde Allavena, Nathalie Allou, João Alves, Rita Vieira Alves, João Alves, Joana Alves Cabrita, Maria João Amaral, Nur Amira, Phoebe Ampaw, Roberto Andini, Claire Andréjak, Andrea Angheben, François Angoulvant, Séverine Ansart, Sivanesen Anthonidass, Massimo Antonelli, Carlos Alexandre Antunes de Brito, Ardiyan Apriyana, Yaseen M. Arabi, Irene Aragão, Francisco Arancibia, Carolline Araujo, Antonio Arcadipane, Patrick Archambault, Lukas Arenz, Jean‐Benoît Arlet, Christel Arnold-Day, Lovkesh Arora, Rakesh C. Arora, Élise Artaud-Macari, Diptesh Aryal, Ángel Asensio, Muhammad Ashraf, Jean‐Baptiste Assié, Amirul Asyraf, Minahel Atif, Anika Atique, Johann Auchabie, Hugues Aumaître, Adrien Auvet, Laurène Azemar, Cécile Azoulay, Benjamin Bach, Delphine Bachelet, Claudine Badr, J. Kenneth Baillie, J. Kevin Baird, Erica Bak, Agamemnon Bakakos, Nazreen Abu Bakar, Andriy Bal, Mohanaprasanth Balakrishnan, Valeria Balan, Firouzé Bani‐Sadr, Renata Barbalho
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.