From AKI to Metabolic Syndrome: Two-Year Follow-Up of Intensive Care Unit (ICU) Survivors of Severe COVID-19

Background: The long-term metabolic and renal consequences of critical illness due to COVID-19 and associated acute kidney injury (AKI) remain poorly characterized. ICU admission often triggers systemic inflammation, hormonal disruption, and prolonged immobilization. These stressors—exacerbated by corticosteroids, parenteral nutrition, and HPA axis dysregulation—may induce or accelerate metabolic syndrome. We evaluated the progression of metabolic parameters in a cohort of post-ICU patients with COVID-19–related AKI Methods: We followed 165 patients with COVID-19–associated AKI (dialysis and non-dialysis) after discharge from ICU. Clinical and laboratory assessments were conducted at 180, 365, and 730 days. Variables included demographics, body weight, abdominal circumference, renal function, albuminuria, and use of antihypertensives, hypoglycemics, and statins. Paired analyses were used to evaluate temporal changes Results: Of the 165 patients, 65% were male; mean age was 54 ± 13.1 years. Body weight increased from 85.6 ± 22 kg (180 days) to 95.4 ± 22 kg (365 days) and 95.1 ± 21 kg (730 days) (p < 0.0001). Abdominal circumference rose from 110.1 ± 15 cm to 114.3 ± 13 cm at 365 days and 113.0 ± 15 cm at 730 days (p < 0.001). Serum creatinine remained stable (1.76 ± 1.5, 1.62 ± 1.3, and 1.68 ± 1.3 mg/dL, respectively). Albuminuria (ACR, mg/g) increased from 193 ± 559 to 100 ± 225 at 365 days, and 360 ± 1034 at 730 days (p < 0.01). Antihypertensive use increased by 16.4% at 365 days and 19.6% at 730 days. Hypoglycemic use rose by 9% and 12.7%, and lipid-lowering therapy by 10.4% and 12.7% at respective time points. LDL rose slightly (114.1 ± 40 to 119.5 ± 38 mg/dL), with no significant change in total cholesterol Conclusion: Patients with COVID-19–related AKI are at high risk of developing metabolic syndrome after ICU discharge, with progressive central obesity, increased use of cardiometabolic medications, and worsening albuminuria—despite stable GFR. These findings highlight the need for early, multidisciplinary intervention to address the long-term metabolic and renal vulnerability of this population.