SARS-CoV-2 infection increases risk of acute kidney injury in a bimodal age distribution
Authors: Bjornstad Erica C. , Cutter Gary , Guru Pramod , Menon Shina , Aldana Isabella , House Scott , M. Tofil Nancy , St. Hill Catherine A. , Tarabichi Yasir , Banner-Goodspeed Valerie M. , Christie Amy B. , Mohan Surapaneni Krishna , Sanghavi Devang , Mosier Jarrod M. , Vadgaonkar Girish , Walkey Allan J. , Kashyap Rahul , Kumar Vishakha K. , Bansal Vikas , Boman Karen , Sharma Mayank , Bogojevic Marija , Deo Neha , Retford Lynn , Gajic Ognjen , Gist Katja M. ,   SCCM Discovery VIRUS Investigators Group, Mesland Jean-Baptiste , Henin Pierre , Petre Hélène , Buelens Isabelle , Gerard Anne-Catherine , Clevenbergh Philippe , Granado Rolando Claure-Del , Mercado Jose A. , Vega-Terrazas Esdenka , Iturricha-Caceres Maria F. , Markotić Dragana , Bošnjak Ivana , Gavidia Oscar Y. , Pachon Felipe , Sanchez Yeimy A. , Knežević Danijel , Kovacevic Tanja , Markic Josko , Ardalic Tatjana Catipovic , Polic Branka , Ivić Ivo , Carev Dominko , Glavinic Robert , El Kassas Mohamed , Badr Mohamed , Tawheed Ahmed , Tawheed Ahmed , Yahia Hend , Kantas Dimitrios , Koulouras Vasileios , Sierra-Hoffman  , Valerio Fernando , Diaz Oscar , Coello Jose Luis Ramos , Perez Guillermo , Lizardo Ana Karen Vallecillo , Guillen Gabina María Reyes , Soto Helin Archaga , Kopitkó Csaba , Bencze Ágnes , Méhész István , Gerendai Zsófia , Doddaga Phaneendra , Chandra Neethi , Vadgaonkar Girish , Ediga Rekha , Basety Shilpa , Dammareddy Shwetha , Kasumalla Phani Sreeharsha , Raju Umamaheswara , Manduva Janaki , Kolakani Naresh , Sripathi Shreeja , Chaitanya Sheetal , Cherian Anusha , Parameswaran Sreejith , Parthiban Magesh , Menu Priya A. , Basavaraja Chetak , Prabhu Madhav , Jakati Vishal , Rijhwani Puneet , Jain Ashish , Gupta Aviral , Jaiswal Ram Mohan , Tyagi Ambika , Mathur Nimish , Daga Mradul Kumar , Agarwal Munisha , Rohtagi Ishan , Papani Sridhar , Kamuram Mahesh , Agrawal Kamlesh Kumar , Baghel Vijendra , Patel Kirti Kumar , Mohan Surapaneni Krishna , Jyothisree Ekambaram , Petrolwala Mukur , Ladva Bharat , Itagaki Yuki , Kodate Akira , Suzuki Reina , Kodate Akira , Takahashi Yuki , Moriki Koyo , Kyo Michihito , Shigemitsu Hidenobu , Mishima Yuka , Nosaka Nobuyuki , Nagashima Michio , Al-Fares Abdulrahman , Rodriguez-Gutierrez Rene , Gonzalez-Gonzalez Jose Gerardo , Salcido-Montenegro Alejandro , Camacho-Ortiz Adrian , Hassan-Hanga Fatimah , Galadanci Hadiza , Gezawa Abubakar Shehu , Kabara Halima M. S. , Amole Taiwo Gboluwaga , Kabir Halima , Haliru Dalha Gwarzo , Ibrahim Abdullahi S. , Asghar Muhammad Sohaib , Syed Mashaal , Naqvi Syed Anosh Ali , Ishaque Sidra , Saleem Ali Faisal , Siddiqui Naveed Ur Rehman , Sherali Salima , Hashwani Yasmin , Ishaque Shafia , Zabolotskikh Igor Borisovich , Zybin Konstantin Dmitrievich , Sinkov Sergey Vasilevich , Musaeva Tatiana Sergeevna , Amer Marwa Ridha , Bawazeer Mohammed Abdullah , Dahhan Talal I. , Kseibi Eiad , Butt Abid Shahzad , Khurshid Syed Moazzum , Rabee Muath , Abujazar Mohammed , Alghunaim Razan , Abualkhair Maal , AlFirm Abeer Turki , Kseibi Eiad , Khurshid Syed Moazzum , Rabee Muath , Abujazar Mohammed , Alghunaim Razan , Alamoudi Razan K. , AlSharif Hassan M. , Almazwaghi Sarah A. , Elsakran Mohammed S. , Aid Mohamed A. , Darwich Mouaz A. , Hagag Omnia M. , Ali Salah A. , Rocacorba Alona , Supeña Kathrine , Juane Efren Ray , Medina Jenalyn , Baduria Jowany , Almazyad Mohammed A. , Alarifi Mohammed I. , Macarambon Jara M. , Bukhari Ahmad Abdullah , Albahrani Hussain A. , Asfina Kazi N. , Aldossary Kaltham M. , Andrijevic Ana , Gavrilovic Srdjan , Carapic Vladimir , Kovacevic Pedja , Stevanovic Predrag D. , Stojakov Dejan S. , Ignjatovic Duska K. , Bojic Suzana C. , Bobos Marina M. , Nenadic Irina B. , Zaric Milica S. , Djuric Marko D. , Djukic Vladimir R. , Teruel Santiago Y. , Martin Belen C. , Teruel Santiago Y. , Gharpure Varsha P. , Raheemi Usman , Dodd Kenneth W. , Goodmanson Nicholas , Hesse Kathleen , Bird Paige , Weinert Chauncey , Schoenrade Nathan , Altaher Abdulrahman , Mayar Esmael , Aronson Matthew , Cooper Tyler , Logan Monica , Miner Brianna , Papo Gisele , Barry Suzanne , Woll Christopher , Wu Gregory , Carrole Erin , Burke Kathryn , Mohammed Mustafa , St. Hill Catherine A. , Melamed Roman R. , Tierney David M. , Patel Love A. , Raj Vino S. , Dawud Barite U. , Mazumder Narayana , Sidebottom Abbey , Guenther Alena M. , Krehbiel Benjamin D. , Schmitz Nova J. , Jepsen Stacy L. , Sipsey Lynn , Schulte Anna , Wunderlich Whitney , Hoyt Cecely , Raval Abhijit A. , Franks Andrea , Irby Katherine , Sanders Ronald C. , Hefley Glenda , Jarvis Jennifer M. , Kharbanda Anmol , Jhajhria Sunil , Fyffe Zachary , Capizzi Stephen , Alicie Bethany , Green Martha , Crockarell Lori , Drennan Amelia , Dubuque Kathleen , Fambrough Tonya , Gasaway Nikole , Krantz Briana , Nebi Peiman , Orga Jan , Serfass Margaret , Simion Alina , Warren Kimberly , Wheeler Cassie , Woolman C. J. , Christie Amy B. , Ashley Dennis W. , Adiga Rajani , Moyer Andrew S. , Verghese George M. , Newsome Andrea Sikora , Forehand Christy C. , Bruning Rebecca , Jones Timothy W. , Sabov Moldovan , Zaidi Fatema , Tissavirasingham Fiona , Malipeddi Dhatri , Mosier Jarrod M. , Lutrick Karen , Campbell Beth Salvagio , Wilson Cathleen , Rivers Patrick , Brinks Jonathan , Mongoh Mokenge Ndiva , Gilson Boris , Armaignac Donna Lee , Parris Don , Zuniga Maria Pilar , Vargas Ilea , Boronat Viviana , Hutton Anneka , Kaur Navneet , Neupane Prashank , Sadule-Rios Nohemi , Rojas Lourdes M. , Neupane Aashish , Rivera Priscilla , Carlos Carlos Valle , Vincent Gregory , Howard Christopher M. , McBride Cameron , Abraham Jocelyn , Garner Orlando , Richards Katherine , Collins Keegan , Antony Preethi , Mathew Sindhu , Danesh Valerie C. , Dubrocq Gueorgui , Davis Amber L. , Hammers Marissa J. , McGahey Ill M. , Farris Amanda C. , Priest Elisa , Korsmo Robyn , Fares Lorie , Skiles Kathy , Shor Susan M. , Burns Kenya , Dowell Corrie A. , Gonzales Gabriela “ Hope” , Flores Melody , Newman Lindsay , Wilk Debora A. , Ettlinger Jason , Bomar Jaccallene , Darji Himani , Arroliga Alejandro , Arroliga Alejandro C. , Dowell Corrie A. , Conzales Gabriela Hope , Flores Melody , Newman Lindsay , Wilk Debora A. , Ettlinger Jason , Darji Himani , Bomar Jaccallene , Khandhar Paras B. , Kring Elizabeth , Banner-Goodspeed Valerie M. , Bose Somnath , Kelly Lauren E. , Joseph Melisa , McGourty Marie , Capers Krystal , Hoenig Benjamin , Karamourtopoulos Maria C. , Law Anica C. , Baedorf Kassis Elias N. , Walkey Allan J. , Waikar Sushrut S. , Garcia Michael A. , Colona Mia , Kibbelaar Zoe , Leong Michael , Wallman Daniel , Soni Kanupriya , Maccarone Jennifer , Gilman Joshua , Devis Ycar , Chung Joseph , Paracha Munizay , Lumelsky David N. , DiLorenzo Madeline , Abdurrahman Najla , Johnson Shelsey , Hersh Maj Andrew M. , Wachs C. P. T. Stephanie L. , Swigger Brittany S. , Wachs C. P. T. Stephanie L. , Sattler Capt Lauren A. , Moulton Capt Michael N. , Miller Aaron S. , Anderson Edwin L. , Nagy Rosemary , Inja Ravali R. , Nawathe Pooja A. , Pedraza Isabel , Tsing Jennifer , Carr Karen , Chaudhary Anila , Guglielmino Kathleen , Tirupathi Raghavendra , Tang Alymer , Safi Arshad , Green Cindy , Newell Jackie , Gist Katja M. , Sayed Imran A. , Brinton John , Strom Larisa , Chiotos Kathleen , Blatz Allison M. , Lee Giyoung , Burnett Ryan H. , Sydney Guy I. , Traynor Danielle M. , Nauert Karissa , Gonzalez Annika , Bagley Mariel , Santpurkar Anita , Cheruku Sreekanth , Ahmed Farzin , Deonarine Christopher , Jones Ashley , Shaikh Mohammad-Ali , Preston David , Chin Jeanette , Vachharajani Vidula , Duggal Abhijit , Rajendram Prabalini , Mehkri Omar , Dugar Siddharth , Biehl Michelle , Sacha Gretchen , Houltham Stuart , King Alexander , Ashok Kiran , Poynter Bryan , Beukemann Mary , Rice Richard , Gole Susan , Shaner Valerie , Conjeevaram Adarsh , Ferrari Michelle , Alappan Narendrakumar , Minear Steven , Hernandez-Montfort Jaime , Nasim Syed Sohaib , Sunderkrishnan Ravi , Sahoo Debasis , Daugherty Steven K. , Atkinson Sam , Shrimpton Kelly , Ontai Sidney , Contreras Brian , Obinwanko Uzoma , Amamasi Nneka , Sharafi Amir , Lee Sarah , Esber Zahia , Jinjvadia Chetna , Waller Christine , Kallies Kara , Thorsen Jonean , Fitzsimmons Alec , Olsen Haley , Dapul Heda R. , Verma Sourabh , Salas Alan , Daube Ariel , Korn Michelle , Ramirez Michelle , Rajagopalan Logi , Santos Laura , Santiago Héctor Collazo , Hernandez Ricardo Alan , Smalls Orma , Malhotra Atul , Husain Abdurrahman , Zawaydeh Qais , Steuernagle J. H. , Davis Steven Q. , Jovic Valentina , Jovic Valentina , Masuda Max , Hayes Amanda , Gossett Kristen Lee , Nason Jennifer , Morris Sarah , Deans Sarah , Houston Stephanie , Smith Michael , Snow William , Liptak Riley , Durant Hannah , Pendleton Valerie , Nanavati Alay , Mrozowsk Risa , Nag Namrata , Brauer Jeff , Dharmadhikari Ashwin , Singh Sahib , Laghi Franco , Naeem Ghania , Wang Andrew , Bliden Kevin , Rout Amit , Barnes Jaime , Gesheff Martin , Thomas Asha , Thomas Melbin , Liendo Alicia R. , Milosavljevic Jovan , Abbasi Kenan , Burley Nicholas B. , Rapista Nicole , Amankwah Samuel , Poudel Sanjay K. , Timilsina Saroj , Sarkar Sauradeep , Akinyosoye Oluwasayo , Yalamanchili Shashi K. , Moorthy Sheena , Sugumar Sonia , Ford Jonathan , Taylor Martin C. , Dunderdale Charlotte , Henshaw Alyssa , Brunk Mary K. , Hagy Jessica , Masood Shehryar , Sridhar Sushrutha , Gupta Manoj K. , Oulds Franscene E. , Nandavar Akshay , Liu Yuk Ming , Zavala Sarah , Zavala Sarah , Shim Esther , Wen Andy Y. , DaCar Allie , Reilkoff Ronald A. , Heneghan Julia A. , Eichen Sarah , Goertzen Lexie , Rajala Scott , Feussom Ghislaine , Tang Ben , Junia Christine C. , Lichtenberg Robert , Sidhu Hasrat , Espinoza Diana , Rodrigues Shelden , Zabala Maria Jose , Goyes Daniela , Susheela Ammu , Hatharaliyadda Buddhi , Rameshkumar Naveen , Kasireddy Amulya , Maldonado Genessis , Beltran Lisseth , Chaugule Akshata , Khan Hassan , Patil Namrata , Patil Ruhi , Cartin-Ceba Rodrigo , Sen Ayan , Palacios Amanda , Mahdi Giyth M. , Kashyap Rahul , Gajic Ognjen , Bansal Vikas , Tekin Aysun , Lal Amos , O’Horo John C. , Deo Neha N. , Sharma Mayank , Qamar Shahraz , Domecq Juan Pablo , Singh Romil , Niven Alex , Bogojevic Marija , La Nou Abigail , Mullen Barbara , Sanghavi Devang , Franco Pablo Moreno , Guru Pramod , Gnanapandithan Karthik , Saunders Hollie , Fleissner Zachary , Garcia Juan , Mateus Alejandra Yu Lee , Yarrarapu Siva Naga , Kaur Nirmaljot , Giri Abhisekh , Khan Syed Anjum , Domecq Juan Pablo , Jain Nitesh Kumar , Koritala Thoyaja , Bastidas Alexander , Orellana Gabriela , Bierwirth Adriana Briceno , Milazzo Eliana , Sierra Juan Guillermo , Dang Thao , Nanchal Rahul S. , Bergl Paul A. , Peterson Jennifer L. , Yamanaka Travis , Barreras Nicholas A. , Markos Michael , Fareeduddin Anita , Mehta Rohan , Venkata Chakradhar , Engemann Miriam , Mantese Annamarie , Tarabichi Yasir , Perzynski Adam , Wang Christine , Kotekal Dhatri , Briceno Bierwirth Adriana C. , Orellana Gabriela M. , Catalasan Gerardo , Ahmed Shohana , Matute Carlos F. , Hamdan Ahmad , Salinas Ivania , Del Nogal Genesis , Tejada Angel , Eschler Anna , Hejna Mary , Lewandowski Emily , Kusmierski Kristen , Martin Clare , Siddiqi Nasar A. , Jurado Lesly , Tincher Lindsey , Brown Carolyn , Sendi Prithvi , Nadiger Meghana , Totapally Balagangadhar , Aulakh Bhagat S. , Tripathi Sandeep , Bandy Jennifer A. , Kreps Lisa M. , Bollinger Dawn R. , Bandy Jennifer A. , Stienecker Roger Scott , Melendez Andre G. , Brunner Tressa A. , Budzon Sue M. , Heffernan Jessica L. , Souder Janelle M. , Miller Tracy L. , Maisonneuve Andrea G. , Redfern Roberta E. , Shoemaker Jessica , Micham Jennifer , Kenney Lynn , Naimy Gabriel , Balcer Holly , Utley Sara , Bouknight Dawn , Patel Radha , Alfehaid Lama , Hamarshi Majdi , Ploetz Jeannette , Bennett Nick , Klindworth Kyle , Younis Moustafa , Mohamed Adham , Vilella Antonia L. , Kutner Sara B. , Clark Kacie , Moore Danielle , Menon Shina , McGuire John K. , Rich Deana , Zaren Howard A. , Smith Stephanie J. , Lewis Grant C. , Seames Lauren , Farlow Cheryl , Miller Judy , Broadstreet Gloria , Martinez Anthony , Allison Micheal , Mittal Aniket , Ruiz Rafael , Skaanland Aleta , Ross Robert , Patel Umang , Hodge Jordesha , Patel Krunal Kumar , Dalal Shivani , Kavani Himanshu , Joseph Sam , Mohabir Paul K. , O’Brien Connor G. , Dasani Komal , Marx William , Amzuta Ioana , Choudhry Asad J. , Azam Mohammad T. , Gupta Neha , Jones Tracy L. , Ayers Shonda C. , Harrell Amy B. , Brown Brent R. , Bhalala Utpal S. , Kuehne Joshua , Garcia Melinda , Beebe Morgan , Herrera Heather , Fiack Chris , Guo Stephanie , Vawer May , Blackburn Beth , Belden Katherine A. , Baram Michael , Weber Devin M. , DePaola Rosalie , Xia Yuwei , Carter Hudson , Tolley Aaron , Barletta Mary , Steele Mark , Kemble Laurie , Denson Joshua L. , Gillet A. Scott , Brown Margo , Stevens Rachael , Wetherbie Andrew , Tea Kevin , Moore Mathew , Sines Benjamin J. , Bice Thomas J. , Dy Rajany V. , Iardino Alfredo , Sharma Jill , Christopher Julia , Mashina Marwan , Patel Kushal , Bjornstad Erica C. , Tofil Nancy M. , House Scott , Aldana Isabella , Meena Nikhil K. , Caceres Jose D. , Meena Nikhil K. , Epps Sarenthia M. , Goraya Harmeen , Besett Kelsey R. , James Ryan , Abusalem Lana Y. , Patel Akash K. , Hasan Lana S. , Stulce Casey W. , Chong Grace , Ghavam Ahmeneh , Mayampurath Anoop , Gomaa Dina , Goodman Michael , Wakefield Devin , Spuzzillo Anthony , Shinn John O. , McGonagill Patrick W. , Galet Colette , Hubbard Janice , Wang David , Allan Lauren , Badheka Aditya , Chegondi Madhuradhar , Nazir Usman , Rampon Garrett , Riggle Jake , Dismang Nathan , Akca Ozan , Lenhardt Rainer , Cavallazzi Rodrigo S. , Jerde Ann , Black Alexa , Polidori Allison , Griffey Haily , Winkler Justin , Brenzel Thomas , Park Pauline , Admon Andrew , Hanna Sinan , Chanderraj Rishi , Pliakas Maria , Wolski Ann , Cirino Jennifer , Dandachi Dima , Regunath Hariharan , Camazine Maraya N. , Geiger Grant. E. , Njai Abdoulie O. , Saad Baraa M. , Shah Faraaz Ali , Chuan Byron , Rawal Sagar L. , Piracha Manal , Tonna Joseph E. , Levin Nicholas M. , Suslavich Kayte , Tsolinas Rachel , Fica Zachary T. , Skidmore Chloe R. , Stapleton Renee D. , Dixon Anne E. , Johnson Olivia , Ardren Sara S. , Burns Stephanie , Raymond Anna , Gonyaw Erika , Hodgdon Kevin , Housenger Chloe , Lin Benjamin , McQuesten Karen , Pecott-Grimm Heidi , Sweet Julie , Ventrone Sebastian , Akhter Murtaza , Rahman Rania Abdul , Mulrow Mary , Wilfong Erin M. , Vela Kelsi , Kashiouris Markos G. , Gal Tamas , Mahashabde Manasi , Vagonis Alexandra , Uber Rebecca , Mahmud Haseeb , Leightle Stefan , Zhang Zoe , Vissichelli Nicole , Karam Oliver , O’Meara Alia , De Carvalho Heloisa , Rocawich Katie , Khanna Ashish K. , Harris Lynne , Cusson Bruce , Fowler Jacob , Vaneenenaam David , McKinney Glen , Udoh Imoh , Johnson Kathleen , Lyons Patrick G. , Michelson Andrew P. , Haluf Sara S. , Lynch Lauren M. , Nguyen Nguyet M. , Steinberg Aaron , Pattan Vishwanath , Papke Jessica , Jimada Ismail , Mhid Nida , Chakola Samuel 
Published: February 2022

Abstract
Background
Hospitalized patients with SARS-CoV2 develop acute kidney injury (AKI) frequently, yet gaps remain in understanding why adults seem to have higher rates compared to children. Our objectives were to evaluate the epidemiology of SARS-CoV2-related AKI across the age spectrum and determine if known risk factors such as illness severity contribute to its pattern.

Methods
Secondary analysis of ongoing prospective international cohort registry. AKI was defined by KDIGO-creatinine only criteria. Log-linear, logistic and generalized estimating equations assessed odds ratios (OR), risk differences (RD), and 95% confidence intervals (CIs) for AKI and mortality adjusting for sex, pre-existing comorbidities, race/ethnicity, illness severity, and clustering within centers. Sensitivity analyses assessed different baseline creatinine estimators.

Results
Overall, among 6874 hospitalized patients, 39.6% (n = 2719) developed AKI. There was a bimodal distribution of AKI by age with peaks in older age (≥60 years) and middle childhood (5–15 years), which persisted despite controlling for illness severity, pre-existing comorbidities, or different baseline creatinine estimators. For example, the adjusted OR of developing AKI among hospitalized patients with SARS-CoV2 was 2.74 (95% CI 1.66–4.56) for 10–15-year-olds compared to 30–35-year-olds and similarly was 2.31 (95% CI 1.71–3.12) for 70–75-year-olds, while adjusted OR dropped to 1.39 (95% CI 0.97–2.00) for 40–45-year-olds compared to 30–35-year-olds.

Conclusions
SARS-CoV2-related AKI is common with a bimodal age distribution that is not fully explained by known risk factors or confounders. As the pandemic turns to disproportionately impacting younger individuals, this deserves further investigation as the presence of AKI and SARS-CoV2 infection increases hospital mortality risk.