Factors associated with acute kidney injury in older adults with COVID-19 during the pre-vaccination period: a cohort study

Abstract

Objective  acute kidney injury occurred in 36.3% of the older adult with COVID-19, 45.5% were men, and most were aged ≥70 years. Overall, 61.2% of patients required hemodialysis, 70.2% did not recover renal function and 63.3% died. On multivariate analysis, acute kidney injury was associated with chronic kidney disease in the conservative stage [OR 8.59 (1.33-55.32), p=0.024], admission to an intensive care unit [OR 3.71 (1.10-12.53), p=0.034] and use of vasoactive drugs [OR 7.07 (2.41-20.79), p<0.001].

Method  acute kidney injury occurred in 36.3% of the older adult with COVID-19, 45.5% were men, and most were aged ≥70 years. Overall, 61.2% of patients required hemodialysis, 70.2% did not recover renal function and 63.3% died. On multivariate analysis, acute kidney injury was associated with chronic kidney disease in the conservative stage [OR 8.59 (1.33-55.32), p=0.024], admission to an intensive care unit [OR 3.71 (1.10-12.53), p=0.034] and use of vasoactive drugs [OR 7.07 (2.41-20.79), p<0.001].

Results  acute kidney injury occurred in 36.3% of the older adult with COVID-19, 45.5% were men, and most were aged ≥70 years. Overall, 61.2% of patients required hemodialysis, 70.2% did not recover renal function and 63.3% died. On multivariate analysis, acute kidney injury was associated with chronic kidney disease in the conservative stage [OR 8.59 (1.33-55.32), p=0.024], admission to an intensive care unit [OR 3.71 (1.10-12.53), p=0.034] and use of vasoactive drugs [OR 7.07 (2.41-20.79), p<0.001].

Conclusion  the identification of the variables involved in this process and implementation of strategies are essential to optimize timely diagnosis and treatment measures to help prevent the occurrence of renal dysfunction and its potential complications.

Keywords
Aged; COVID-19; Acute Kidney Injury; Risk Factors; Hospitalization

Resumo

Objetivo  analisar a incidência de injúria renal aguda e os fatores associados em pessoas idosas com covid-19 no período pré-vacinação.

Métodos  estudo de coorte retrospectivo, realizado com 137 indivíduos, com idade igual e superior a 60 anos e diagnóstico confirmado de covid-19, internados em hospital público, na cidade do Recife, Pernambuco, Brasil, no período de abril de 2020 a abril de 2021. Os dados foram analisados por meio da estatística descritiva, inferencial e análise de regressão logística multivariada.

Resultados  a injúria renal aguda ocorreu em 36,3% das pessoas idosas com covid-19, sendo 45,5% homens, com predomínio de indivíduos com 70 anos ou mais. Foi observada uma incidência de 61,2% de pacientes necessitando de hemodiálise, dos quais 70,2% não recuperaram a função renal e 63,3% faleceram. Na análise multivariada, a injúria renal aguda foi associada à doença renal crônica no estágio conservador [OR 8,59 (1,33-55,32), p=0,024], internação em unidade de terapia intensiva [OR 3,71 (1,10-12,53), p=0,034] e uso de drogas vasoativas [OR 7,07 (2,41-20,79), p<0,001].

Conclusão  a identificação das variáveis envolvidas nesse processo e a implementação de estratégias são fundamentais para otimizar o diagnóstico oportuno e medidas de tratamento a fim de dirimir a ocorrência de disfunção renal e de suas potenciais complicações.

Palavras-Chave:
Idoso; Covid-19; Injúria Renal Aguda; Fatores de Risco; Hospitalização

INTRODUCTION

The infection disease of the novel coronavirus (COVID-19), caused by the virus Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), compromises upper and lower airways and can severely affect other organs, such as the kidneys. High rates of morbimortality and prolonged disease progression can be seen in vulnerable population groups such as older adults, immunosuppressed individuals, and those with cardiopathy, Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM)¹.

The older population is more vulnerable to infection by SARS-CoV-2, and to developing negative outcomes, typically presenting more severe clinical symptoms, longer disease duration, greater need for admission to the Intensive Care Unit (ICU) and use of Mechanical Ventilation (MV), factors which are associated with pre-existing comorbidities. This susceptibility is due to the immunosenescence of older individuals, aggravated by the existence of chronic metabolic disorders which exacerbate immunosuppression, predisposing them to infection by COVID-19 and its complications².

Acute Kidney Injury (AKI) is a hospital complication that has a high incidence in older adults, characterized by rapid reduction in renal function which leads to serious consequences, such as high mortality rate, greater risk of progression to Chronic Kidney Disease (CKD) and increased need for invasive procedures and therapeutic interventions³.

Epidemiological data indicate that AKI affects over 13 million people worldwide, causing death in around 1.7 million cases. The prevalence of the condition varies depending on the population studied and protocol used for diagnosis and staging, with AKI observed in 7-18% of hospitalized patients, half of whom are admitted to ICUs⁴.

A scoping review found that AKI secondary to COVID-19 occurs in roughly a third of critical patients during the course of the hospital stay, with most cases worsening and requiring Renal Replacement Therapy (RRT), while over 80% of patients on MV develop AKI⁵.

Increased morbimortality, prolonged hospital stay and high health costs are some of the consequences of AKI in older adults with COVID-19, representing a public health problem. In Brazil, during the pre-vaccination period (2020), 53% of deaths from COVID-19 involved older individuals, highlighting the vulnerability of this group amid the pandemic. With the advent of vaccination for COVID-19 in Brazil, there was a shift in the epidemiological profile of the disease, culminating in a reduction in the number of cases, and a decline in the rates of complications⁶.

Given the high incidence of AKI, together with the diversity and complexity of factors associated with older adults with kidney injury during the period prior to vaccination against COVID-19, the present study addresses the need to further knowledge on the incidence of this problem during the natural course of the disease, and its association with variables involved in the process. The study results can inform strategies targeting the factors that contribute to progression of the condition in an effort to prevent injury.

Therefore, the objective of the present study was to analyze the incidence of Acute Kidney Injury and associated factors in older adults with COVID-19.

METHOD

A retrospective cohort study with a quantitative approach was conducted between April 2020 and April 2021. The study complied with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology)⁷ guidelines, ensuring quality and transparency in reporting of the study. The casuistic comprised 137 patient records of older adults admitted to the medical ward and COVID ICU of a university hospital situated in the city of Recife, Pernambuco state, Brazil. The study adopted a census sampling approach, precluding the need for sample size calculation.

The study included individuals aged ≥60 years, of both genders, and diagnosed with COVID-19, as confirmed by the real-time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test using a nasopharyngeal swab, and whose hospital stay was >24 hours. Subjects with previous history of stage 4 or 5 CKD, and/or undergoing RRT prior to admission, were excluded. All patient records of older adults with conservative stage CKD were included in the study.

Data collection was performed by a trained research team. Secondary data were extracted from patient records of older adults with COVID-19, where the dependent variable and main outcome was ARI. This outcome was identified based on the clinical diagnosis duly registered in the medical record, categorized according to its occurrence. The independent variables elected for the study were: sociodemographic variables (sex, age, marital status, ethnicity, personal income, education, area of residence, and city of provenance), clinical variables (presence of comorbidities, DM, SAH, CKD, ICU admission, length of hospital stay, MV use, time on MV, AKI occurrence, hemodialysis (HD), AKI reversal, vasoactive drug use and clinical outcome), lifestyle variables obtained using self-report criteria at hospital admission and registered in the medical record (tobacco and alcohol use).

During treatment of the older adults with COVID-19, the above-mentioned data were collected at the following timepoints: hospital admission, ward admission, ward complication, ICU admission, and 12 hours after ICU admission.

The data obtained were analyzed using descriptive inferential statistics, and by multivariate logistic regression analysis.

In order to characterize the sociodemographic, clinical and lifestyle profile of the patients assessed, percent frequencies were calculated and their respective frequency distributions constructed.

Analysis of the factors associated with the presence of AKI was performed by constructing contingency tables and applying Pearson´s chi-square test of independence or Fisher´s exact test. A 5% level of significance was adopted for all analyses.

The criteria for entry of the variables into the multivariate logistic regression model was a significance level of up to p=0.20 (20%) on bivariate analysis, where the model was adjusted with robust variance to assess the chances of developing AKI. Variables reaching a 5% level of significance were retained in the model. Confidence intervals (CI) were also calculated for odds ratios, and Wald´s test was applied to compare chances of developing AKI among the levels of the factors studied.

The study was approved by the local Research Ethics Committee (CEP) under permit no.5.791.775. The ethical and legal precepts established in Resolution 466/12 governing Research Standards involving Human Subjects⁸ were observed, as was Resolution 510/2016, governing standards applicable to studies in Human and Social Science⁹. Given the study was based on secondary data collected from patient medical records of the health facility in a retrospective and anonymous manner, the need for Free and Informed Consent Forms was waived.

RESULTS

Of the 137 patient records included in the study, 49 had AKI during the hospital stay (36.3%), of which 16 (32.7%) were discharged and 31 (63.3%) died. Compared against the group without AKI, patients from the AKI group had a higher mortality rate and worse outcome, as depicted in the flow diagram showing study participant selection and outcome of AKI in hospitalized older adults with COVID-19 (Figure 1).

Figure 1
Flow diagram of selection of records of study participants and outcome of acute kidney injury in hospitalized older adults with COVID-19, Recife city, Pernambuco state, 2023.

For the total 137 patient records, regarding distribution of AKI according to sociodemographic profile, participants were predominantly men (45.5%), aged ≥70 years (40.0%), had a partner (40.0%), >9 years of education (50.0%), were non-white (36.0%), had a low family income of ≤1 minimum salary (40.4%), lived in the urban area (36.7%), and were from the metropolitan region of Recife city, Pernambuco state, Brazil (37.1%). On the bivariate analysis, only sex was associated with AKI (p-value=0.030) (Table 1).

Table 1
Sociodemographic factors potentially associated with Acute Kidney Injury in hospitalized older adults with COVID-19. Recife city, Pernambuco state, 2023.

Variables		Acute Kidney Injury		p-value
	n(%)	Yes	No
Sex
Male	68(49.6)	30.0 (45.5%)	36(54.5%)	0.030¹
Female	69 (50.4)	19.0 (27.5%)	50(72.5%)
Age (years)
60-69	66(48.2)	21(32.3%)	44(67.7%)	0.353¹
≥70	71(51.8)	28(40.0%)	42(60.0%)
Marital status*
With partner	72(54.5)	28(40.0%)	42(60.0%)	0.432¹
Without partner	60(45.5)	20(33.3%)	40(66.7%)
Education*
Illiterate	38(29.7)	13(35.1%)	24(64.9%)	0.215¹
≤9 years	69(53.9)	20(29.0%)	49(71.0%)
>9 years	21(16.4)	10(50.0%)	10(50.0%)
Ethnicity*
White	26(20.5)	8(32.0%)	17(68.0%)	0.708¹
Non-white	101(79.5)	36(36.0%)	64(64.0%)
Income*
≤1 MW	52(61.2)	21(40.4%)	31(59.6%)	0.582¹
>1 MW	33(38.8)	11(34.4%)	21(65.6%)
Area of residence
Urban	111(81)	40(36.7%)	69(63.3%)	0.843¹
Rural	26(19)	9(34.6%)	17(65.4%)
Provenance
Recife/MR of Recife	98(71.5)	36(37.1%)	61(62.9%)	0.752¹
Outside MR of Recife	39(28.5)	13(34.2%)	25(65.8%)

• ¹Pearson chi-square test of independence. *Categories where data loss occurred. MW: Minimum Wage; MR: Metropolitan Region. Source: authors, 2023.

The highest rate of kidney injury occurred in patients with no comorbidities (43.7%). Regarding the presence of comorbidities, AKI was associated with conservative stage CKD (75.0%) and predominated in the group of individuals that had no SAH (40.0%), never smoked (36.4%), used alcohol (41.7%), required ICU admission (55.7%), had length of hospital stay ≥30 days (44.4%), were on MV (45.2%), used MV for ≥30 days (47.6%), and used vasoactive drugs (70.0%). Although a higher rate of kidney injury was found in the group of older adults with the profile described, the test of independence reached significance only for the factors conservative CKD (p-value <0.001), ICU admission (p-value <0.001), MV use (p-value =0.001) and Vasoactive drug use (p-value <0.001) (Table 2).

Table 2
Clinical and lifestyle factors potentially associated with Acute Kidney Injury in hospitalized older adults with COVID-19. Recife city, Pernambuco state, 2023.

Variables	n(%)	Acute Kidney Injury		p-value
		Yes	No
Comorbidities
Yes	120(88.2)	42(35.6%)	76(64.4%)	0.525¹
No	16(11.8)	7(43.7%)	9(56.3%)
Diabetes Mellitus
Yes	67(50.4)	27(40.9%)	39(59.1%)	0.404¹
No	66(49.6)	22(33.8%)	43(66.2%)
Hypertension
Yes	97(72.9)	35(36.5%)	61(63.5%)	0.711¹
No	36(27.1)	14(40.0%)	21(60.0%)
Conservative CKD
Yes	20(15.0)	15(75.0%)	5(25.0%)	<0.001¹
No	113(85.0)	34(30.6%)	77(69.4%)
ICU admission
Yes	70(51.1)	39(55.7%)	31(44.3%)	<0.001¹
No	67(48.9)	10(15.4%)	55(84.6%)
Length of hospital stay
<30 days	118(86.8)	41(35.0%)	76(65.0%)	0.440¹
≥30 days	18(13.2)	8(44.4%)	10(55.6%)
MV
Yes	93(68.4)	42(45.2%)	51(54.8%)	0.001¹
No	43(31.6)	7(16.7%)	35(83.3%)
Time on MV
≤ 30 days	82(93.2)	39(47.6%)	43(52.4%)	0.681²
> 30 days	6(6.80)	2(33.3%)	4(66.7%)
Vasoactive drugs
Yes	50(38.8)	35(70.0%)	15(30.0%)	<0.001¹
No	79(61.2)	11(13.9%)	68(86.1%)
Tobacco use
Yes	12(11.7)	3(25.0%)	9(75.0%)	0.774¹
Ex-smoker	58(56.3)	19(33.3%)	38(66.7%)
Never smoked	33(32.0)	12(36.4%)	21(63.6%)
Alcohol use
Yes	12(14.0)	5(41.7%)	7(58.3%)	0.533²
No	74(86.0)	24(32.9%)	49(67.1%)

• ¹Chi-sqaure test for independence; ²p-value of Fisher´s exact test; CKD: Chronic Kidney Disease; ICU: Intensive Care Unit; MV: Mechanical Ventilation. Source: authors, 2023.

The multivariate logistic model included the variables: sex (p-value =0.030), conservative CKD (p-value <0.001), ICU admission (p-value <0.001), MV (p-value =0.001) and Vasoactive drug use (p-value <0.001). After adjusting for confounding variables, CKD at conservative stage (p-value <0.001), ICU admission (p-value <0.001), MV (p-value =0.001), and use of vasoactive drugs (p-value <0.001) had statistical significance <0.05, constituting potential good predictors for AKI.

The group of individuals with CKD at the conservative stage had 8.59 times the chance of developing AKI compared to the group without conservative CKD. Patients admitted to ICU had 3.71 times the chance of developing AKI compared to those not admitted to the ICU. Individuals who used vasoactive drugs had 7.07 times the chance of developing AKI compared to non-users (Table 3).

Table 3
Final fit of multivariate logistic model for estimation of Acute Kidney Injury in hospitalized older adults with COVID-19. Recife city, Pernambuco state, 2023.

Variables	OR	CI(95%)	p-value
Conservative CKD
Yes	8.59	1.33 – 55.32	0.024
No	1.00	-	-
ICU admission
Yes	3.71	1.10 – 12.53	0.034
No	1.00	-	-
Vasoactive drug
Yes	7.07	2.41 – 20.79	<0.001¹
No	1.00	-	-

• OR = Odds Ratio; CI = Confidence Interval; ¹Wald test; CKD= Chronic Kidney Disease; ICU= Intensive Care Unit. Source: authors, 2023

The results show that most patients from the group with AKI underwent HD (61.2%), had no reversal of the condition (70.2%) and died (63.3%), revealing a worse prognosis. Most patients (98.8%) without AKI did not require HD, and had the clinical outcome of hospital discharge or transfer to another hospital (84.9%). The homogeneity test was significant for all factors assessed (p-value ≤0.05), indicating that the distribution of prognosis for patients with kidney injury differed statistically (Table 4).

Table 4
Distribution of hemodialysis, Acute Kidney Injury reversal and clinical outcome, according to presence or absence of Acute Kidney Injury in hospitalized older adults with COVID-19. Recife city, Pernambuco state, 2023.

Variables	Acute Kidney Injury		p-value
	Yes	No
HD
Yes	30(61.2%)	0(0.0%)	<0.001²
No	19(38.8%)	86(100.0%)
AKI reversal
Yes	14(29.8%)	-	-
No	33(70.2%)	-
Clinical Outcome
Discharge	16(32.7%)	67(77.9%)	<0.001¹
Death	31(63.3%)	13(15.1%)
Transfer	2(4.1%)	6(7.0%)

• ¹Chi-square test for homogeneity. ²p-value of Fisher exact test. HD: hemodialysis. Source: authors, 2023.

DISCUSSION

Acute Kidney Injury occurred in over a third of the older adult patients investigated and was associated with the presence of CKD at the conservative stage, ICU admission, and use of vasoactive drugs. The rate of AKI found in the present study proved similar to that reported by a retrospective cohort study, in which 44.9% of the older adults assessed had kidney injury¹⁰. Another cohort study, performed in China, identified a similar prevalence of renal dysfunction of 39% in the population analyzed that affected only older individuals and was associated with high morbimortality and greater need for invasive procedures¹¹.

The present study results revealed the highest incidence of AKI occurred among older individuals aged >70 years. Older age is a known predictor of renal dysfunction. In this context, an observational study conducted in Stockholm corroborated this fact in an analysis of older individuals for the presence or otherwise of COVID-19 associated with the development of AKI during hospitalization. The investigation found that COVID-19 patients had higher occurrence of AKI (29%), greater chance of presenting renal dysfunction, and worse inflammatory markers index, highlighting the viral disease as a factor predisposing to kidney injury during hospitalization. Patients with COVID-19-induced AKI had an 80 times higher mortality rate and longer hospital stay¹².

The predisposition for AKI secondary to COVID-19 in the older population can be explained by SARS-COV-2´s tropism in tubules and renal podocytes, leading to direct injury of the target organ. The phenomenon can also be explained by the systemic inflammatory process, responsible for the renal inflammation status seen with aging, where the kidneys undergo structural remodeling and morphological-functional changes including glomerulosclerosis, intra-renal vascular changes, progressive nephron loss and reduced Glomerular Filtration Rate (GFR)¹³. This evidences the role of COVID-19 in promoting AKI, as well as in exacerbating the condition among older adults. The older population is characterized by a higher prevalence of comorbidities and associated polypharmacy, increasing the risk of nephrotoxicity and AKI, due to the altered pharmacokinetics and pharmacodynamics in this age group¹⁴.

Comorbidities play a role in aggravating COVID-19 and its complications in older individuals, with a high mortality in this population in the era before the COVID-19 vaccine, accounting for 69.3% of deaths, of which 64% had at least 1 morbidity. These figures demonstrate that the risk of severity is directly proportional to older age associated with the existence of chronic diseases¹⁵.

Following the rollout of immunization in Brazil against SARS-CoV-2, there was a decline in the number of cases of infection, ICU admissions and deaths due to COVID-19 in older adults harboring comorbidities, with a 46.26% decrease in notified cases. Regarding hospitalization in intensive beds, a study showed that only 7.14% of older individuals with comorbidities were sent to the ICU, showing the impact of the vaccine for reducing severe cases compared with the pre-vaccination scenario when ICUs were stretched beyond capacity. Deaths from COVID-19 fell from 8 to 2 cases in the cited study, indicating the effectiveness of the vaccine for reducing and preventing fatal cases¹⁶.

In the current cohort, having CKD at the conservative stage proved a predictor of renal complications and was associated with 8.9 times the chance of developing AKI compared to patients without CKD. A cohort study in China found similar results, identifying a high prevalence of patients with COVID-19 at a Chinese hospital, with kidney disease on admission and progression to in-hospital AKI. The rate of renal dysfunction was higher in patients with estimated GFR <60 ml/min/1.73m² (13.1%), and with elevated serum creatinine (14.4%) and urea (13.1%), respectively. The study noted that renal disease on hospital admission was associated with ICU admission and need for MV, representing greater risk for organ deterioration and AKI¹⁷. An investigation in Milan found that the majority of patients developing kidney injury (and with subsequent need for RRT) had CKD¹⁸.

Another cohort study supported the role of preexisting CKD as a precursor of AKI, in which 45% of patients that developed kidney injury (22.6%) showed acute worsening of preexisting CKD, whose prevalence was 28.6%. Having CKD was associated with a 2-fold higher risk of developing AKI¹⁹.

CKD, as a risk factor for AKI, may be associated with advanced age and multimorbidity, which contribute to outcome during hospitalization. Thus, there is greater likelihood of older individuals progressing to AKD upon exposure to factors that can trigger renal insult, given the pre-existing impairment in the respective population¹⁷.

A marked decrease in estimated GFR renders older adults more prone to developing AKI, given the presence of structural and functional changes, fewer working nephrons and drop in glomerular filtrate, which typically accompany the aging process. This condition is aggravated by exposure to agents that promote kidney damage¹³. GFR is influenced by factors including age, sex and race, and may also be negatively impacted by the presence of chronic multi-morbidities and long hospital stays. Scientific evidence reveals that decline in GFR predicts renal dysfunction and greater morbimorbidity¹⁴, ²⁰.

In this study, ICU admission was considered a primordial factor for the development of AKI, and was shown to be associated with other markers of severity and organ deterioration which explain renal dysfunction, namely: long hospital stay (44.4%), need for MV (45.2%) and use of vasoactive drugs (70%). The literature shows that 8-15% of patients with COVID-19 progress to a more a severe form and require ICU admission, with long hospital stay, greater time in intensive care and higher prevalence of AKI²¹. A recent meta analysis found that the rate of in-hospital AKI was 3%, rising to 19% among individuals requiring intensive care, highlighting the risk of renal dysfunction associated with this care setting and its possible implications, representing potential risk factors for AKI²².

The profile of COVID-19 ICU patients reveals a scenario where many individuals exhibit hemodynamic instability and clinical severity, with the need for tests, intensive care, and invasive procedures, such as the use of MV and infusion of drugs for hemodynamic support²³. Therefore, it is evident that treatment complexity, coupled with the variety of different drugs, such as vasoactive and nephrotoxic agents, sedatives and contrasts, contributes to renal overload and collapse, with greater susceptibility to ARI. In addition, patients requiring intensive support and ICU admission for COVID-19 are often older adults with a higher number of comorbidities, in use of more medications to control underlying diseases, and a greater prevalence of hydroelectrolytic and acid-base imbalances, which constitute known risk factors for kidney injury, further increasing the chances of its occurrence¹⁸.

The use of vasoactive drugs was shown to be a strong predictor for AKI in the cohort, with these agents administered in 70% of AKI cases and associated with 7.07 times the odds for the outcome compared to non-users of these drugs. A cross-sectional study of data on patients hospitalized in an ICU in Pernambuco state, Brazil, corroborates this result, showing that 8.3% of patents who developed AKI used vasoactive drugs such as noradrenalin, nitroglycerin and dobutamine. When associated with MV, this rate soars to 45.9%²⁴. Another study in the Brazilian state of Parana reported similar results, showing that around 70% patients who used vasopressor agents developed renal dysfunction. The rate of nephrotoxicity of vasoactive drugs, more specifically dobutamine, epinephrine and vasopressin, reached 50%²⁵.

This strong association is explained by the characteristics of COVID-19 ICU patients, who have more critical clinical status, are more exposed to procedures and therapies inherent to the setting, such as orotracheal intubation, puncture for central venous access and use of vasoactive drugs. Vasoactive compounds are considered nephrotoxic and increase the chances of developing ARI, causing vasoconstriction and renal hypoperfusion, resulting in ischemia and Acute Tubular Necrosis (ATN)²⁶.

The study has some limitations, including the fact that sample size calculations were not possible owing to the use of the census sampling approach. However, the dearth of studies on the topic in the older population prompts investigation of this little researched area, set against the relevance and impact of future treatments, providing a broad range of opportunities for innovation. Hence, these new perspectives can pave the way for future studies. Lastly, the uniqueness of the study adds to the scientific knowledge and helps support clinical decision-making.

CONCLUSION

The rate of AKI among the older adults with COVID-19 was high, and its incidence was associated with CKD at the conservative stage, ICU admission, and use of vasoactive drugs. In view of the role played by AKI in the clinical course of COVID-19 in older adults and its possible outcomes, screening of its potential risk factors is paramount. Likewise early detection of changes in renal function in this population is important to help implement strategies for optimizing timely diagnosis and devise treatments in an effort to prevent the occurrence of renal dysfunction and its potential complications.

Thus, studies exploring the early detection of signs and symptoms of COVID-19 in hospital wards should be conducted, along with investigations in ICUs with protocols adopting measures to prevent renal dysfunction, given the importance of this issue in the biopsychosocial and economic context of older adults.

• There was no funding for the execution of this work.
• DATA AVAILABILITY
  The complete dataset underpinning the results of the present study are available on the Open Science Framework (OSF) and can be accessed at https://doi.org/10.17605/OSF.IO/K2NXF.

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Edited by

• Edited by: Camila Alves dos Santos

Data availability

The complete dataset underpinning the results of the present study are available on the Open Science Framework (OSF) and can be accessed at https://doi.org/10.17605/OSF.IO/K2NXF.

Publication Dates

• Publication in this collection
  27 Jan 2025
• Date of issue
  2025

History

• Received
  24 Apr 2024
• Accepted
  05 Oct 2024