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Characteristics and Determinants of COVID-19-Associated AKI Among Patients of COVID-19 in Rivers State, Nigeria

Received: 8 July 2023    Accepted: 24 July 2023    Published: 5 August 2023
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Abstract

Background: Severe acute respiratory coronavirus-2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) is reportedly associated with acute renal injuries (AKI). However, this has been characterized majorly among Caucasians who have pre-existing confounding comorbidities that may also induce AKI, and hence, limit the conclusions of these previous studies. Consequently, the current study evaluated AKI incidence and associated factors among Nigerian COVID-19 patients of Negroid race who are without any pre-existing comorbid conditions. Methods: This was a retrospectively-designed observational study conducted among COVID-19 patients who presented at a COVID-19-designated treatment facility in Port Harcourt, Nigeria. Demographic, medical, and laboratory data obtained upon presentation were acquired and analyzed by AKI status using descriptive and inferential statistics. Results: Upon presentation, AKI occurred among 46.4% (n=181) of the entire studied population (n=390) which were majorly of stage 1, etiologically pre-renal, community-acquired, and of transient clinical course. Most of the AKI occurred among males, those with severe COVID-19 variants, and those who are unvaccinated against the disease. Those with COVID-19-associated AKI also had higher levels of peak plasma creatinine, plasma C-reactive protein, serum D-dimer, plasma osmolality, proteinuria, and hematuria but lower levels of within 24-hour urine volume, urine specific gravity, and urine osmolality compared to the non-AKI sub-group upon presentation. However, AKI patients with concurrent severe COVID-19 had a higher preponderance of stage 3, intra-renal and persistent AKI compared to patients with non-severe COVID-19 disease. In multivariate models, severe COVID-19 variant (OR: 6.017; CI: 5.880–6.422; p<0.001), the need for ICU transfer/treatment (OR: 3.210; CI: 3.119–3.341; p<0.001), serum D-dimer levels (OR: 3.967; CI: 3.688-4.297; p<0.001), and proteinuria (OR: 2.008; CI: 1.971–2.174; p=0.002) were independent risk factors for AKI among the studied population. Conclusion: AKI is common among COVID-19 patients independent of pre-existing comorbidities. The various COVID-19-associated AKI risk factors identified in the current study are valuable parameters that may guide clinical management among COVID-19 patients.

Published in World Journal of Medical Case Reports (Volume 4, Issue 3)
DOI 10.11648/j.wjmcr.20230403.12
Page(s) 35-43
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

COVID-19, COVID-19 Severity, COVID-19-Induced AKI

References
[1] Li J, Lai S, Gao GF, Shi W. The emergence, genomic diversity and global spread of SARS-CoV-2. Nature. 2021; 600 (7889): 408-18.
[2] Louis TJ, Qasem A, Abdelli LS, Naser SA. Extra-Pulmonary Complications in SARS-CoV-2 Infection: A Comprehensive Multi Organ-System Review. Microorganisms. 2022; 10 (1): 153.
[3] Głowacka M, Lipka S, Młynarska E, Franczyk B, Rysz J. Acute Kidney Injury in COVID-19. Int J Mol Sci. 2021; 22 (15): 8081. DOI: 10.3390/ijms22158081.
[4] Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. J. Am. Soc. Nephrol. 2020; 31: 1157–65.
[5] Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020; 98 (1): 209-18.
[6] Costa RL, Sória TC, Salles EF, Gerecht AV, Corvisier MF, Menezes MA, et al. Acute kidney injury in patients with Covid-19 in a Brazilian ICU: incidence, predictors and in-hospital mortality. Braz J Nephrol. 2021; 43: 349-58.
[7] Ibrahim OR, Oloyede T, Gbadamosi H, Musa Y, Aliu R, Bello SO, et al. Acute kidney injury in COVID–19: A single–center experience in Nigeria. Anaesth Pain Intensive Care. 2021; 25 (4): 470-7.
[8] Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci. 2006; 1: 9–14.
[9] Omunakwe HE, Bob-Manuel M, Enyinnaya SO, Kattey KA, Kpaluku CA. Asymptomatic COVID Infections in Port Harcourt, Nigeria. Niger J Med. 2021; 30 (6): 675-7.
[10] Kellum JA., Lameire N, Aspelin P, Barsoum RS, Burdmann EA., Goldstein SL, et al. Kidney Disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int. Suppl. 2012; 1–138.
[11] Bell JS, James BD, Al-Chalabi S, Sykes L, Kalra PA, Green D. Community- versus hospital-acquired acute kidney injury in hospitalized COVID-19 patients. BMC Nephrol. 2021; 22 (1): 269. DOI: 10.1186/s12882-021-02471-2.
[12] Heller F, Frischmann S, Grünbaum M, Zidek W, Westhoff TH. Urinary calprotectin and the distinction between prerenal and intrinsic acute kidney injury. Clin J Am Soc Nephrol. 2011; 6 (10): 2347-55.
[13] Makris K, Spanou L. Acute kidney injury: diagnostic approaches and controversies. The Clinical Biochemist Reviews. 2016; 37 (4): 153.
[14] Heavens KR, Kenefick RW, Caruso EM, Spitz MG, Cheuvront SN. Validation of equations used to predict plasma osmolality in a healthy adult cohort. Am J Clin Nutr. 2014; 100 (5): 1252-6.
[15] De Jesus Vidal-Mayo J, Olivas-Martinez A, Perez-Diaz I, Lopez-Navarro JM, Sanchez-Landa E, Carrillo-Maravilla E, et al. Calculated Versus Measured Urine Osmolarity: Accuracy of Estimated Urine Density. Rev Invest Clin. 2018; 70 (6): 310-8.
[16] Nigerian Centre for Disease Control (NCDC) National Interim Guidelines for Clinical Management of COVID-19. Accessed 25th December 2022.
[17] Chan L, Chaudhary K, Saha A, Chauhan K, Vaid A, Zhao S, et al. AKI in Hospitalized Patients with COVID-19. J Am Soc Nephrol. 2021; 32 (1): 151-60.
[18] Ounci E, Boukabous S, Bkiyar H, Abda N, Bentata Y, Housni B. Acute kidney injury in critically ill patients with COVID-19: prevalence, risk factors and mortality in eastern Morocco. J Nephrol. 2022; 35 (9): 2383-86.
[19] Hansrivijit P, Gadhiya KP, Gangireddy M, Goldman JD. Risk Factors, Clinical Characteristics, and Prognosis of Acute Kidney Injury in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Medicines (Basel). 202; 8 (1): 4. DOI: 10.3390/medicines8010004.
[20] Procaccini FL, Alcázar Arroyo R, Albalate Ramón M, Torres Aguilera E, Martín Navarro J, Ryan Murua P, et al. Acute kidney injury in 3182 patients admitted with COVID-19: a single-center, retrospective, case-control study. Clin Kidney J. 2021; 14 (6): 1557-69.
[21] Radulescu D, Tuta LA, David C, Bogeanu C, Onofrei SD, Stepan E, et al. Acute kidney injury in moderate and severe COVID-19 patients: Report of two university hospitals. Exp Ther Med. 2022; 23 (1): 37. DOI: 10.3892/etm.2021.10959.
[22] Martínez-Rueda AJ, Álvarez RD, Méndez-Pérez RA, Fernández-Camargo DA, Gaytan-Arocha JE, Berman-Parks N, et al. Community- and Hospital-Acquired Acute Kidney Injury in COVID-19: Different Phenotypes and Dismal Prognosis. Blood Purif. 2021; 50 (6): 931-41.
[23] Lu JY, Babatsikos I, Fisher MC, Hou W, Duong TQ. Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19. Front Med (Lausanne). 2021; 8: 647023. DOI: 10.3389/fmed.2021.647023.
[24] Tan BWL, Tan BWQ, Tan ALM, Schriver ER, Gutiérrez-Sacristán A, Das P, et al. Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: An international multi-center observational cohort study. EClinicalMedicine. 2022; 55: 101724. DOI: 10.1016/j.eclinm.2022.101724.
[25] Kumar GK, Kumar NS, Alok N, Krishna B. Evaluation of Dynamics of Renal Recovery in COVID-19 Patients with Acute Kidney Injury Admitted to Intensive Care Unit: An Observational Study (COVID-AKI Study). Indian J Crit Care Med. 2022: S52-4.
[26] Fukao Y, Nagasawa H, Nihei Y, Hiki M, Naito T, Kihara M, et al. COVID-19-induced acute renal tubular injury associated with elevation of serum inflammatory cytokine. Clin Exp Nephrol. 2021; 25 (11): 1240-46.
[27] Alexander MP, Mangalaparthi KK, Madugundu AK, Moyer AM, Adam BA, Mengel M, et al. Acute Kidney Injury in Severe COVID-19 Has Similarities to Sepsis-Associated Kidney Injury: A Multi-Omics Study. Mayo Clin Proc. 2021; 96 (10): 2561-75.
[28] Oweis AO, Alshelleh SA, Hawasly L, Alsabbagh G, Alzoubi KH. Acute Kidney Injury among Hospital-Admitted COVID-19 Patients: A Study from Jordan. Int J Gen Med. 2022; 15: 4475.
[29] Karras A, Livrozet M, Lazareth H, Benichou N, Hulot JS, Fayol A, et al. Proteinuria and Clinical Outcomes in Hospitalized COVID-19 Patients: A Retrospective Single-Center Study. Clin J Am Soc Nephrol. 2021; 16 (4): 514–21.
[30] Amadi C, Lawson S, Amadi B, Agbo E. Correlation of plasma albumin status with markers of hepato-biliary dysfunction and Systemic Inflammation Among COVID-19 Patients. Biomed Sci. 2022; 8 (1): 41-8.
[31] Amadi C, Lawson S. The Impact of Systemic Inflammation on Sex-based Bias Following SARS-CoV-2 Infection. Eur J Clin Biomed Sci. 2022; 8 (1): 1-8.
[32] Lawson S, Amadi C. Assessment of surrogate markers/indices of inflammation among COVID-19 patients with and without comorbid conditions. Am J Lab Med. 2022; 7 (1): 16-22.
[33] Lawson S, Amadi C. Potentials of varied inflammatory indices in the prediction of COVID-19 severity among Nigerians. Adv Biochem. 2022; 10 (1); 18-24.
[34] Amadi B, Lawson S, Amadi C. Hypokalemia and Its correlates among Nigerian SARS-CoV-2 infected patients. Biomed Sci. 2022; 8 (1); 20-27.
[35] Demir E, Dheir H, Safak S, Serra Artan A, Sipahi S, Turkmen A. Differences in clinical outcomes of COVID-19 among vaccinated and unvaccinated kidney transplant recipients. Vaccine. 2022; 40 (24): 3313-19.
[36] Miao J, Olson E, Houlihan S, Kattah A, Dillon J, Zoghby Z. Effects of SARS-CoV-2 vaccination on the severity of COVID-19 infection in patients on chronic dialysis. J Nephrol. 2023: 1–8.
[37] Ronco C, Reis T, Husain-Syed F. Management of acute kidney injury in patients with COVID-19. Lancet Respir. Med. 2020; 8: 738–42.
[38] Ahmed AR, Ebad CA, Stoneman S, Satti MM, Conlon PJ. Kidney injury in COVID-19. World J. Nephrol. 2020; 9: 18–32.
[39] Sharma P, Uppal NN, Wanchoo R, Shah HH, Yang Y, Parikh R., et al. COVID-19–Associated Kidney Injury: A Case Series of Kidney Biopsy Findings. J. Am. Soc. Nephrol. 2020; 31: 1948–58.
Cite This Article
  • APA Style

    Ochuko Otokunefor, Collins Amadi, Kelachi Thankgod Wala, Emmanuel Mustapha Owamagbe, Bright Chike Amadi, et al. (2023). Characteristics and Determinants of COVID-19-Associated AKI Among Patients of COVID-19 in Rivers State, Nigeria. World Journal of Medical Case Reports, 4(3), 35-43. https://doi.org/10.11648/j.wjmcr.20230403.12

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    ACS Style

    Ochuko Otokunefor; Collins Amadi; Kelachi Thankgod Wala; Emmanuel Mustapha Owamagbe; Bright Chike Amadi, et al. Characteristics and Determinants of COVID-19-Associated AKI Among Patients of COVID-19 in Rivers State, Nigeria. World J. Med. Case Rep. 2023, 4(3), 35-43. doi: 10.11648/j.wjmcr.20230403.12

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    AMA Style

    Ochuko Otokunefor, Collins Amadi, Kelachi Thankgod Wala, Emmanuel Mustapha Owamagbe, Bright Chike Amadi, et al. Characteristics and Determinants of COVID-19-Associated AKI Among Patients of COVID-19 in Rivers State, Nigeria. World J Med Case Rep. 2023;4(3):35-43. doi: 10.11648/j.wjmcr.20230403.12

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  • @article{10.11648/j.wjmcr.20230403.12,
      author = {Ochuko Otokunefor and Collins Amadi and Kelachi Thankgod Wala and Emmanuel Mustapha Owamagbe and Bright Chike Amadi and Adekemi Layo Kiyesi and Chidozie Johnbosco Okafor and Ini John Ntuenibok},
      title = {Characteristics and Determinants of COVID-19-Associated AKI Among Patients of COVID-19 in Rivers State, Nigeria},
      journal = {World Journal of Medical Case Reports},
      volume = {4},
      number = {3},
      pages = {35-43},
      doi = {10.11648/j.wjmcr.20230403.12},
      url = {https://doi.org/10.11648/j.wjmcr.20230403.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20230403.12},
      abstract = {Background: Severe acute respiratory coronavirus-2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) is reportedly associated with acute renal injuries (AKI). However, this has been characterized majorly among Caucasians who have pre-existing confounding comorbidities that may also induce AKI, and hence, limit the conclusions of these previous studies. Consequently, the current study evaluated AKI incidence and associated factors among Nigerian COVID-19 patients of Negroid race who are without any pre-existing comorbid conditions. Methods: This was a retrospectively-designed observational study conducted among COVID-19 patients who presented at a COVID-19-designated treatment facility in Port Harcourt, Nigeria. Demographic, medical, and laboratory data obtained upon presentation were acquired and analyzed by AKI status using descriptive and inferential statistics. Results: Upon presentation, AKI occurred among 46.4% (n=181) of the entire studied population (n=390) which were majorly of stage 1, etiologically pre-renal, community-acquired, and of transient clinical course. Most of the AKI occurred among males, those with severe COVID-19 variants, and those who are unvaccinated against the disease. Those with COVID-19-associated AKI also had higher levels of peak plasma creatinine, plasma C-reactive protein, serum D-dimer, plasma osmolality, proteinuria, and hematuria but lower levels of within 24-hour urine volume, urine specific gravity, and urine osmolality compared to the non-AKI sub-group upon presentation. However, AKI patients with concurrent severe COVID-19 had a higher preponderance of stage 3, intra-renal and persistent AKI compared to patients with non-severe COVID-19 disease. In multivariate models, severe COVID-19 variant (OR: 6.017; CI: 5.880–6.422; p Conclusion: AKI is common among COVID-19 patients independent of pre-existing comorbidities. The various COVID-19-associated AKI risk factors identified in the current study are valuable parameters that may guide clinical management among COVID-19 patients.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Characteristics and Determinants of COVID-19-Associated AKI Among Patients of COVID-19 in Rivers State, Nigeria
    AU  - Ochuko Otokunefor
    AU  - Collins Amadi
    AU  - Kelachi Thankgod Wala
    AU  - Emmanuel Mustapha Owamagbe
    AU  - Bright Chike Amadi
    AU  - Adekemi Layo Kiyesi
    AU  - Chidozie Johnbosco Okafor
    AU  - Ini John Ntuenibok
    Y1  - 2023/08/05
    PY  - 2023
    N1  - https://doi.org/10.11648/j.wjmcr.20230403.12
    DO  - 10.11648/j.wjmcr.20230403.12
    T2  - World Journal of Medical Case Reports
    JF  - World Journal of Medical Case Reports
    JO  - World Journal of Medical Case Reports
    SP  - 35
    EP  - 43
    PB  - Science Publishing Group
    SN  - 2994-726X
    UR  - https://doi.org/10.11648/j.wjmcr.20230403.12
    AB  - Background: Severe acute respiratory coronavirus-2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) is reportedly associated with acute renal injuries (AKI). However, this has been characterized majorly among Caucasians who have pre-existing confounding comorbidities that may also induce AKI, and hence, limit the conclusions of these previous studies. Consequently, the current study evaluated AKI incidence and associated factors among Nigerian COVID-19 patients of Negroid race who are without any pre-existing comorbid conditions. Methods: This was a retrospectively-designed observational study conducted among COVID-19 patients who presented at a COVID-19-designated treatment facility in Port Harcourt, Nigeria. Demographic, medical, and laboratory data obtained upon presentation were acquired and analyzed by AKI status using descriptive and inferential statistics. Results: Upon presentation, AKI occurred among 46.4% (n=181) of the entire studied population (n=390) which were majorly of stage 1, etiologically pre-renal, community-acquired, and of transient clinical course. Most of the AKI occurred among males, those with severe COVID-19 variants, and those who are unvaccinated against the disease. Those with COVID-19-associated AKI also had higher levels of peak plasma creatinine, plasma C-reactive protein, serum D-dimer, plasma osmolality, proteinuria, and hematuria but lower levels of within 24-hour urine volume, urine specific gravity, and urine osmolality compared to the non-AKI sub-group upon presentation. However, AKI patients with concurrent severe COVID-19 had a higher preponderance of stage 3, intra-renal and persistent AKI compared to patients with non-severe COVID-19 disease. In multivariate models, severe COVID-19 variant (OR: 6.017; CI: 5.880–6.422; p Conclusion: AKI is common among COVID-19 patients independent of pre-existing comorbidities. The various COVID-19-associated AKI risk factors identified in the current study are valuable parameters that may guide clinical management among COVID-19 patients.
    VL  - 4
    IS  - 3
    ER  - 

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Author Information
  • Department of Chemical Pathology, University of Port Harcourt, Port Harcourt, Nigeria

  • Department of Chemical Pathology, PAMO University of Medical Sciences, Port Harcourt, Nigeria

  • Department of Chemical Pathology, Rivers State University/Rivers State University Teaching Hospital, Port Harcourt, Nigeria

  • Department of Chemical Pathology, Rivers State University/Rivers State University Teaching Hospital, Port Harcourt, Nigeria

  • Department of Chemical Pathology, Rivers State University/Rivers State University Teaching Hospital, Port Harcourt, Nigeria

  • Department of Chemical Pathology, Rivers State University/Rivers State University Teaching Hospital, Port Harcourt, Nigeria

  • Department of Chemical Pathology, University of Uyo Teaching Hospital, Uyo, Nigeria

  • Department of Chemical Pathology, University of Uyo, Uyo, Nigeria

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