Acute Kidney Injury in Hospitalized Patients with COVID-19

Abstract

Importance: Preliminary reports indicate that acute kidney injury (AKI) is common in coronavirus disease (COVID)-19 patients and is associated with worse outcomes. AKI in hospitalized COVID-19 patients in the United States is not well-described. Objective: To provide information about frequency, outcomes and recovery associated with AKI and dialysis in hospitalized COVID-19 patients. Design: Observational, retrospective study. Setting: Admitted to hospital between February 27 and April 15, 2020. Participants: Patients aged ≥18 years with laboratory confirmed COVID-19 Exposures: AKI (peak serum creatinine increase of 0.3 mg/dL or 50% above baseline). Main Outcomes and Measures: Frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aOR) with mortality. We also trained and tested a machine learning model for predicting dialysis requirement with independent validation. Results: A total of 3,235 hospitalized patients were diagnosed with COVID-19. AKI occurred in 1406 (46%) patients overall and 280 (20%) with AKI required renal replacement therapy. The incidence of AKI (admission plus new cases) in patients admitted to the intensive care unit was 68% (553 of 815). In the entire cohort, the proportion with stages 1, 2, and 3 AKI were 35%, 20%, 45%, respectively. In those needing intensive care, the respective proportions were 20%, 17%, 63%, and 34% received acute renal replacement therapy. Independent predictors of severe AKI were chronic kidney disease, systolic blood pressure, and potassium at baseline. In-hospital mortality in patients with AKI was 41% overall and 52% in intensive care. The aOR for mortality associated with AKI was 9.6 (95% CI 7.4-12.3) overall and 20.9 (95% CI 11.7-37.3) in patients receiving intensive care. 56% of patients with AKI who were discharged alive recovered kidney function back to baseline. The area under the curve (AUC) for the machine learned predictive model using baseline features for dialysis requirement was 0.79 in a validation test. Conclusions and Relevance: AKI is common in patients hospitalized with COVID-19, associated with worse mortality, and the majority of patients that survive do not recover kidney function. A machine-learned model using admission features had good performance for dialysis prediction and could be used for resource allocation.

Acute kidney injury in Colombian patients with COVID-19 who received kidney support therapy with genius® 90 technology

“…In our study we found that the median of age of patients with AKI secondary to COVID-19 was similar to other published studies such as Hirsch, et al and Chan, et al [9,10]. However, a meta-analysis published recently composed primarily of Chinese patients showed a great variability in the age, including patients from 47 to 70 years old [11].…”

“…The median of creatinine on admission in our study differs from the one reported in other studies [9,10]. This is due to the fact that the serum creatinine obtained in our study was previous to the start of RRT; additionally, our data came from medical charts, not having the baseline serum creatinine previous to hospitalization.…”

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

“…However, we found a pooled AKI prevalence of 32% and a New York report cited 46% of hospitalized and 68% of ICU COVID-19 cases with AKI with 34% of those in ICU requiring replacement renal therapy (RRT), and with an OR of 20.9 (95% CI 11.7 to 37.3) for AKI vs non-AKI associated ICU mortality [58]. Along with our analysis, this raises the concern that AKI maybe seriously under appreciated in critically ill COVID-19 patients.…”

COVID-19 ICU and mechanical ventilation patient characteristics and outcomes - A systematic review and meta-analysis

“…of ICU COVID-19 cases with AKI with 34% of those in ICU requiring replacement renal therapy (RRT), and with an OR of 20.9 (95% CI 11.7-37.3) for AKI vs non-AKI associated ICU mortality [58].…”