AKI in Hospitalized Patients with and without COVID-19: A Comparison Study

Abstract

BackgroundReports from centers treating patients with coronavirus disease 2019 (COVID-19) have noted that such patients frequently develop AKI. However, there have been no direct comparisons of AKI in hospitalized patients with and without COVID-19 that would reveal whether there are aspects of AKI risk, course, and outcomes unique to this infection.MethodsIn a retrospective observational study, we evaluated AKI incidence, risk factors, and outcomes for 3345 adults with COVID-19 and 1265 without COVID-19 who were hospitalized in a large New York City health system and compared them with a historical cohort of 9859 individuals hospitalized a year earlier in the same health system. We also developed a model to identify predictors of stage 2 or 3 AKI in our COVID-19.ResultsWe found higher AKI incidence among patients with COVID-19 compared with the historical cohort (56.9% versus 25.1%, respectively). Patients with AKI and COVID-19 were more likely than those without COVID-19 to require RRT and were less likely to recover kidney function. Development of AKI was significantly associated with male sex, Black race, and older age (>50 years). Male sex and age >50 years associated with the composite outcome of RRT or mortality, regardless of COVID-19 status. Factors that were predictive of stage 2 or 3 AKI included initial respiratory rate, white blood cell count, neutrophil/lymphocyte ratio, and lactate dehydrogenase level.ConclusionsPatients hospitalized with COVID-19 had a higher incidence of severe AKI compared with controls. Vital signs at admission and laboratory data may be useful for risk stratification to predict severe AKI. Although male sex, Black race, and older age associated with development of AKI, these associations were not unique to COVID-19.

Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury

“…1,7 Previous studies have been limited by small sample size; incomplete follow-up; or have not focused primarily on survival or kidney outcomes. [24][25][26] Our current study of almost 10000 hospitalized patients with COVID-19 with 99%…”

Acute Kidney Injury in COVID-19: The Chinese Experience

“…Recently published studies on COVID-19 worldwide reported AKI rates in hospitalized patients of 17.9-72.7% in Italy 29,30 , 9.2-18.3% in Korea 31,32 , 19.7-69.2% in Spain 33,34 , 5.8-56.9% in USA 35,36 , 52.2-74.6% in Germany 37,38 , and 4.7-64.1% in France and Belgium 39,40 , which are much higher than the rates in China. The difference may be explained by the fact that only very sick COVID-19 patients were admitted to hospitals in those countries compared to the admission of less sick patients in China.…”

Adverse impact of renin-angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study

“…Severe COVID-19 was associated with multiple organ injuries such as ARDS [25][26][27] and AKI [28][29][30] , which were identi ed as independent risk factors for mortality in patients with COVID-19. However, the association of ACE-I or ARB use with AKI or ARDS is still not fully understood.…”