Acute kidney injury in patients hospitalized with COVID-19 in Wuhan, China: A single-center retrospective observational study

Xiao, Gao; Hu, Hongbin; Wu, Feng; Sha, Tong; Huang, Qiaobing; Li, Haijun; Han, Jiafa; Song, Wenhong; Chen, Zhongqing; Zeng, Zhenhua

doi:10.1101/2020.04.06.20055194

Cited by 44 publications

(49 citation statements)

References 10 publications

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“…At variance with previous findings where AKI was more represented among males [28], we did not find a significant difference in sex distribution among our AKI patients. Similarly, the use of ACE-Is or ARBs was not associated with an increased risk of AKI at multivariate analysis.…”

Section: Discussioncontrasting

confidence: 99%

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

et al. 2020

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Background The prevalence of kidney involvement during SARS-CoV-2 infection has been reported to be high. Nevertheless, data are lacking about the determinants of acute kidney injury (AKI) and the combined effect of chronic kidney disease (CKD) and AKI in COVID-19 patients. Methods We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution. Chronic kidney disease was defined as eGFR < 60 mL/min per 1.73 m2 or proteinuria at urinalysis within 180 days prior to hospital admission. AKI was defined according to KDIGO criteria. The primary and secondary outcomes were the development of AKI and death. Results Of 777 patients eligible for the study, acute kidney injury developed in 176 (22.6%). Of these, 79 (45%) showed an acute worsening of a preexisting CKD, and 21 (12%) required kidney replacement therapy. Independent associates of AKI were chronic kidney disease, C-reactive protein (CRP) and ventilation support. Among patients with acute kidney injury, 111 died (63%) and its occurrence increased the risk of death by 60% (HR 1.60 [95% IC 1.21–2.49] p = 0.002) independently of potential confounding factors including hypertension, preexisting kidney damage, and comorbidities. Patients with AKI showed a significantly higher rate of deaths attributed to bleeding compared to CKD and the whole population (7.5 vs 1.5 vs 3.5%, respectively). Conclusion Awareness of kidney function, both preexisting CKD and development of acute kidney injury, may help to identify those patients at increased risk of death.

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Section: Discussioncontrasting

confidence: 99%

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

et al. 2020

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“…The findings from our study are in consonance with those from prior studies suggesting that AKI is a significant risk factor of clinical deterioration and in-hospital death among COVID-19 patients [3,4,6,26]. Patients who developed HA-AKI had poorer outcomes than those with CA-AKI.…”

Section: Color Version Available Onlinesupporting

confidence: 91%

Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

Pelayo

Bhargav

et al. 2020

Cardiorenal Med

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Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO 2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121-13.231, p = 0.032). Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.

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“…In another retrospective study of 333 patients, about 75% experienced urine dipstick abnormalities or AKI (40). In the first studies during the pandemic spread, incidence of AKI was reported from 3 to 9% of patients, but more recent studies reported an incidence rate of 15% (17,41). In one observational study of 5,449 hospitalized patients, the incidence of AKI was 36.6 with 14.3% of patients requiring dialysis and was even higher in patients admitted to the ICU (42).…”

Section: Kidney Involvement During Covid-19mentioning

confidence: 98%

“…In a single-center, retrospective, observational study of 287 patients, 55 patients presented with AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO). These patients were significantly older, more likely male, and with other comorbidities, including chronic renal insufficiency, hypertension, and cerebrovascular disease, and tended to have more severe pneumonia (not peer-reviewed) (41). Of these patients, 14.3% presented with AKI at stage 1, while 4.9% of patients presented with stage 2 or 3 (41).…”

Section: Kidney Involvement During Covid-19mentioning

confidence: 99%

COVID-19 and the Kidneys: An Update

et al. 2020

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The new coronavirus disease 2019 (COVID-19) has become a world health emergency. The disease predominantly effects individuals between 30 and 79 years of age with 81% of cases being classified as mild. Despite the majority of the general population displaying symptoms similar to the common cold, COVID-19 has also induced alveolar damage resulting in progressive respiratory failure with fatalities noted in 6.4% of cases. Direct viral injury, uncontrolled inflammation, activation of coagulation, and complement cascades are thought to participate in disease pathogenesis. Patients with COVID-19 have displayed kidney damage through acute kidney injury, mild proteinuria, hematuria, or slight elevation in creatinine possibly as consequence of kidney tropism of the virus and multiorgan failure. The impact of COVID-19 on patients with pre-existing kidney impairment, including those with chronic kidney disease, kidney transplant recipients, and individuals on hemodialysis (HD) has not yet been clearly established. No specific treatments for COVID-19 have been found yet. Research has revealed several agents that may have potential efficacy against COVID-19, and many of these molecules have demonstrated preliminary efficacy against COVID-19 and are currently being tested in clinical trials.

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Acute kidney injury in patients hospitalized with COVID-19 in Wuhan, China: A single-center retrospective observational study

Cited by 44 publications

References 10 publications

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

COVID-19 and the Kidneys: An Update

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