Background Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality. Conclusions Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.

Serum bilirubin may predict the progression of CKD in patients with type 2 diabetes and preserved kidney function.

Serum albumin is a major determinant of hospitalization in patients with end‐stage renal disease (ESRD). Previous reports generally use the Poisson model to evaluate the relationships between outcome and response variables. However, hospitalization data are often overdispersed, and few studies using appropriate methods exist in the literature.This retrospective cohort study included 426 patients with ESRD receiving hemodialysis treatment between 2014 and 2018. Using a negative binomial regression model with hierarchical multivariable adjustments, we investigated the relationship between serum albumin, hospital admissions, and total hospitalization days. Mean age and mean baseline serum albumin levels were 64.7 ± 11 years and 3.5 ± 0.5 g/dL, respectively. At least one hospitalization was identified in 402 (94%) patients. The incidence rate was 1.48 (95% CI, 1.41‐1.56) admissions per patient‐year during the follow‐up period of 5 years. A negative linear association was observed between serum albumin and hospitalization frequency. Hospitalization rates (95% CI) were 1.81 (1.65‐1.98), 1.44 (1.3‐1.59), 1.36 (1.22‐1.51), and 1.33 (1.2‐1.48) per patient‐year in serum albumin levels ≤3, 3.1 to ≤3.3, 3.4 to ≤3.7, and ≥3.8 g/dL, respectively. Case mix‐adjusted incidence rate ratio was 0.82 (95% CI, 0.70‐0.94), while it was robust to further adjustments for malnutrition and inflammation markers. Similar results were observed in hospitalization days and time to the first hospitalization. These findings, which result from the negative binomial model using overdispersed data, suggest that lower serum albumin is related to increased hospitalization rates and hospital days in incident hemodialysis patients.

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Introduction and Aims: Synthetic cannabinoid (SCs) use has been increasing in Turkey parallel to the rest of the world. It is more commonly named as bonzai, jamaica, k2 or spice and is used illegally for pleasure and hallucinogenic effects. Here we presented six patients who were followed up in Nephrology clinic with acute kidney injury (AKI) due to synthetic cannabinoid usage in last six months . Methods: Single centre experience; Here we presented six patients who were followed up in Nephrology clinic with acute kidney injury (AKI) due to synthetic cannabinoid usage in last six months . Results: Six male patients aged between 28-42 years were admitted to the nephrology clinic, after presenting to the ER with nausea, vomiting and abdominal pain and whose laboratory results showed high levels of urea and creatinine. Clinical and laboratory findings in all six patients are summarized in Table 1. The most evident complaints of patients were nausea and vomiting. The patients declared that nausea-vomiting started approximately 10-16 hours before coming to the ER and approximately 2-4 hours after inhalation. All 6 cases have abdominal pain starting from the epigastric region and felt more severely in both lumbar regions. Metabolic alkalosis was observed in 4, normoacidemia in 2 patients. Kidney biopsies were performed in 2 of the cases (Case 3 and 5) revealed evidence of acute tubular necrosis, focal tubular atrophy, flattened and granulated epithelium and interstitial fibrosis. On the other hand; hypertrophic and global sclerotic glomerulies were observed. Vessels were unremarkable, with no significant staining on the immunofluorescence. Conclusions: SCs using is growing up daily, particularly in young generation and becoming a serious public health threat. In less than 6 months, a total of 6 cases were hospitalised in our clinic and unfortunately 4 of them (%66) became dependent on