Acute kidney injury in patients hospitalized with COVID-19

Hirsch, Jamie S.; Ng, Jia H.; Ross, Daniel W.; Sharma, Purva; Shah, Hitesh H.; Barnett, Richard; Hazzan, Azzour D.; Fishbane, Steven; Jhaveri, Kenar D.

doi:10.1016/j.kint.2020.05.006

Cited by 1,280 publications

(1,847 citation statements)

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“…The same group in another publication observed proteinuria in 65.8% of 333 hospitalized patients [14]. Hirsch et al [15] found a prevalence of 42.1%, by dipstick results, in 646 patients in New-York City.…”

Section: Discussionmentioning

confidence: 83%

Proteinuria in COVID-19: prevalence, characterization and prognostic role

Huart

Bouquegneau

Lutteri

et al. 2020

Preprint

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Background: Proteinuria has been commonly reported in patients with COVID-19, suggesting a renal involvement in this infection. However, only dipstick tests have been used thus far. Here, the quantification and characterization of proteinuria and hematuria are investigated. Their potential association with mortality was assessed. Methods: This retrospective, observational and monocentric study includes 153 patients hospitalized with COVID-19 between March 28th and April 30th 2020, in whom total proteinuria and urine α1-microglobulin (a marker of tubular injury) have been measured. Association with mortality was evaluated with a follow-up until May 7th 2020. Results: According to the Kidney Disease Improving Global Outcomes staging, 14% (n=21) had stage 1 proteinuria (<150 mg/g of urine creatinine), 42% (n=64) had stage 2 (between 150 and 500 mg/g) and 44% (n=68) had stage 3 (over 500 mg/g). Urine α1-microglobulin concentration was higher than 10 or 15 mg/g in 94% and 89% of patients, respectively. After a median follow-up of 27 [14;30] days, the mortality rate reached 18%. Total proteinuria and urine α1-microglobulin (as continuous and/or categorical variables) were associated with mortality in unadjusted and adjusted models. This association was even stronger in subgroups of patients with normal renal function or without urinary catheter. Conclusions: Proteinuria is frequent in patients with COVID-19. Its characterization suggests a tubular origin with increased urine α1-microglobulin. Tubular proteinuria seems associated with mortality in COVID-19.

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Section: Discussionmentioning

confidence: 83%

Proteinuria in COVID-19: prevalence, characterization and prognostic role

Huart

Bouquegneau

Lutteri

et al. 2020

Preprint

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“…Thirdly, mechanical respiratory support including the level of PEEP is critical in developing AKI in SARS-COV-2. As described by Hirsch et al, SARS-CoV-2 ventilated patients are at greater risk of developing AKI than non-ventilated ones (89.7% vs. 21.7%), especially during the rst 24 hours following intubation (31).…”

Section: Discussionmentioning

confidence: 95%

SARS-COV2 Renal Impairment in Critical Care: A Retrospective Study of 42 Cases - Kid COVID Study

Pardo

Galichon

et al. 2020

Preprint

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BackgroundThe new coronavirus (SARS-CoV-2) infection leads to 5% to 16% hospitalization in Intensive Care Units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI), as a major prognosis factor. The current work aims to characterize the renal impairment associated to SARS-CoV-2 in ICU patients, to evaluate its risk factors and its relationship with morbidity and mortality. Methods Forty-two patients consecutively admitted to the ICU of a university hospital (Paris, France) who tested positive for SARS-CoV-2 between March 25, 2020 and April 29, 2020 were included and classified in categories according to their renal function. Complete renal profiles and their evolution during ICU stay were fully characterized in 34 patients. Factors associated with AKI were identified through univariate analysis.ResultsThirty-two patients (94,1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, that lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (p = 0.027), PEEP (p = 0.027), procalcitonin (p = 0.015), and CRP (p = 0.045) on ICU admission.ConclusionsCritical SARS-CoV-2 is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Identifying SARS-CoV-2 patients at risk of AKI will help in modifying clinical practice in ICU. Trial registration In accordance with the French law on biomedical research, this study obtained the approval of an Institutional Review Board (“Comité d’Éthique de la Recherche en Anesthésie-Réanimation” under the reference IRB 00010254 ‐ 2020 ‐ 106). Patients were all informed of the possible use of their data in researches as well as their right and terms of objection. Data were collected and integrated anonymously into a secure database in accordance with the French CNIL MR-004 methodology (registration number 20200803123416).

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“…Overall, COVID-19 patients were included in our meta-analysis. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The pooled estimated incidence of AKI in all hospitalized COVID-19 patients was 12.0% (95% CI: 9.0%-15.0%, Fig. 2), and a signi cant heterogeneity (I 2 = 98%, Chi-square = 0.19, P < 0.01) was observed ( Table 3).…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Whether Remdesivir Increases the Risk of Acute Kidney Injury (AKI) in Patients with COVID-19: A Systematic Review and Meta-Analysis

Xu¹,

Tang²,

Huang³

et al. 2020

Preprint

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Background: Acute kidney injury (AKI) occurs among patients with COVID-19, it is also proved to be associated with in-hospital mortality. Remdesivir, an RNA polymerase inhibitor, has shown its antiviral activity in vitro and animal models. The adverse effect of Remdesivir especially AKI is the most common cause which lead to drug discontinuation. Whether Remdesivir increases the risk of AKI in patients with COVID-19 is not clear. We conducted a systematic review and meta-analysis to evaluate the incidence rate of AKI in hospitalized COVID-19 patients and whether Remdesivir increases the risk of AKI. Methods: A thorough search was carried out to find relevant studies in PubMed, medRxiv, and Web of Science from 1 Jan 2020 till 1 June 2020. 15135 COVID-19 patients and 981 COVID-19 patients using Remdesivir were included in our meta-analysis. Results: The pooled estimated incidence of AKI in all hospitalized COVID-19 patients was 12.0% (95% CI:9.0%-15.0%). According to our subgroup study, the incidence of AKI was associated with the age, disease severity and race of patients. The incidence of AKI in hospitalized COVID-19 patients using Remdesivir was 6% (95% CI: 3%-13%) with a total of 5 studies. Comparing with COVID-19 patients without Remdesivir treatment, Remdesivir treatment do not increase the risk of AKI in COVID-19 patients showing OR 0.80(95%CI: 0.44-1.46, P>0.05). Conclusions: We found out that AKI was not rare in hospitalized COVID-19 patients. The incidence of AKI was associated with age, disease severity and race. Remdesivir treatment did not increase the risk of AKI in hospitalized COVID-19 patients. Our meta-analysis may provide an evidence for future study that AKI is associated with the natural cause of COVID-19, not the adverse event after the usage of Remdesivir.

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Acute kidney injury in patients hospitalized with COVID-19

Cited by 1,280 publications

References 28 publications

Proteinuria in COVID-19: prevalence, characterization and prognostic role

Proteinuria in COVID-19: prevalence, characterization and prognostic role

SARS-COV2 Renal Impairment in Critical Care: A Retrospective Study of 42 Cases - Kid COVID Study

Whether Remdesivir Increases the Risk of Acute Kidney Injury (AKI) in Patients with COVID-19: A Systematic Review and Meta-Analysis

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