Acute Kidney Injury in a Predominantly African American Cohort of Kidney Transplant Recipients With COVID-19 Infection.

Shrivastava, Pritika; Prashar, Rohini; Khoury, Nadeen; Patel, Anita; Yeddula, Sirisha; Kitajima, Toshihiro; Nagai, Shunji; Samaniego, Milagros

Renal involvement in severe or critical acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is frequent. Acute kidney injury (AKI) in African American (AA) kidney transplant recipients (KTRs) with COVID-19 is not well described. We report our experience with a predominantly AA cohort (79%) of KTRs with COVID-19 infections in the Detroit Metropolitan area. METHODS In this retrospective, single-center study, we identified 39 KTRs who tested positive for SARS-CoV-2 between March 16 and April 25th, 2020. Data from electronic medical records were retrieved and compared between KTRs without AKI and KTRs with AKI. RESULTS One pt was excluded due to DGF. Final analysis of AKI in KTRs with proven COVID-19 was done on 38 patients of which 30 were AA (79%). AKI occurred in 71.1% of COVID-19 KTRs (n=27), of whom 6 (22.2%) patients required HD. The incidence of AKI in our cohort was 71% (27/38). AKI rate among AA was 76.7% vs. 50% in non-AA cohort (p=0.195). In a univariate logistic regression analysis, AA race was not significantly associated with AKI OR (3.4, CI [0.68-17.4], p=0.14). After risk adjustment by race, patients with diabetes showed a significantly higher risk of AKI (adjusted OR 19.85 CI [1.65-58.66], p=0.012). KTRs with AKI had more preexisting RAAS inhibitor use than KTRs without AKI (P=0.03). CONCLUSIONS KTRs infected with SARS-CoV-2 have a high incidence of AKI, with associated increased morbidity and mortality. Though no racial differences in mortality were noted in our KTRs with AKI, we await data from registries to help elucidate this difference.