Hospital-acquired AKI in COVID-19 has a similar prognosis with or without prior community-acquired AKI

Background: Recent meta-analyses suggest that Hospital Acquired AKI (HA) has a worse prognosis than Community Acquired AKI (CA). The effect of prior CA on HA in COVID-19 is largely unknown. COVID-19 case series that use lowest hospital creatinine (Cr) rather than outpatient baseline Cr may underestimate CA incidence. Methods: Excluding ESKD and hospital transfers, COVID-19 PCR confirmed cases admitted to 4 hospitals between 3/01/20 & 5/31/20 had data collected through 7/31/20 including readmissions. Baseline Cr was adjudicated by manual review from 6 months prior until 5 months post admission. AKI and renal recovery were scored using KDIGO staging. CA is AKI with the highest Cr on admission, rising Cr from admission, or RRT in 48 hrs of admission. HA is AKIs occurring after >48 hrs. HA with CA (HA+CA) is AKI occurring in CA patients after renal recovery for > 48 hrs. Results: AKI was present in 402 of 706 patients with COVID-19. HA+CA occurred in 63. Patients with HA+CA were older, had more comorbidities, lower eGFR, and lower admission albumin than patients with HA. Laboratory markers of COVID severity were similar in patients with HA or HA+CA and much worse than CA. Outcomes, including stage of AKI, renal recovery, ICU parameters, and mortality were similar in HA and HA+CA and much better in CA. Conclusions: In COVID-19, HA + CA occurs in older patients with more comorbidities than HA but shares similar adverse disease markers and poor outcomes. We hypothesize that among older patients who recover from CA, those with severe disease markers are at risk for HA+CA.