Background 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.
Objectives 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.
Methods 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.
Results 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).
Conclusion 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.

Title

BMC Infectious Diseases

Publisher

BioMed Central

Publisher Country

United Kingdom

Indexing

Thomson Reuters

Impact Factor

3.21

Publication Type

Prtinted only

Volume

27

Year

2026

Pages

1-17