Acute kidney injury in hospitalized COVID-19 patients: predictors, risk factors, mortality, and renal recovery from a bi-center cohort in Palestine

Acute kidney injury (AKI) is a prevalent and serious complication in hospitalized COVID-19 patients, associated with increased morbidity and mortality. Data from low- and middle-income regions remain insufficient. To examine the incidence, predictors, risk factors, renal recovery, and mortality of acute kidney injury (AKI) in hospitalized COVID-19 patients within a bi-center cohort in Palestine. A retrospective cohort analysis involving 435 adult patients with confirmed COVID-19 infection admitted to Al-Makassed Hospital and Augusta Victoria Hospital in East Jerusalem from March 2020 to March 2022. Acute Kidney Injury (AKI) was categorized and staged in accordance with Kidney Disease Improving Global Outcomes (KDIGO) criteria. We employed multivariable logistic regression to identify predictors of acute kidney injury and mortality. 32.2% (140 out of 435) of patients experienced AKI. The majority of AKI cases were male (60%) and over 60 years of age (74.3%). 70.7% of people with AKI experienced severe COVID-19. AKI was significantly associated with Intensive Care Unit (ICU) admission (45%) and invasive ventilation. Stage 1AKI was observed in 60%, stage 2 in 21.4%, and stage 3 in 18.6% of cases. Renal recovery occurred in 63.6% of cases, whereas death reached 35.7%. AKI was a significant risk factor for mortality (OR 3.5, 95% Confidence Interval 2.16–5.66). Independent mortality predictors included severe COVID-19, ICU hospitalization, invasive ventilation, elevated inflammatory markers (CRP, D-dimer, lactate), and increased peak creatinine and blood urea nitrogen (BUN) levels. A greater stage of AKI was significantly associated with worse renal outcomes and increased mortality ( p < 0.001). AKI is a prevalent complication among hospitalized COVID-19 patients in Palestine, associated with elevated mortality and restricted renal recovery. The principal determinants of outcome are disease severity, intensive care unit management, and inflammatory load.