AKI in Hospitalized Patients with COVID-19

Abstract

Background Early reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described. Methods This retrospective, observational study involved a review of data from electronic health records of patients aged $18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality. Results Of 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up. Conclusions AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.

Time and the etiology of Acute Kidney Injury define prognosis in the course of COVID-19

“…In a recent meta-analysis, it was found that 52% of patients who developed AKI died [13]. Another study showed that, chronic kidney disease and male sex were independent predictors of AKI severity [14]. However, as seen in our cohort, consequences of all AKIs in COVID-19 are not the same.…”

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

“…While the reported incidence of AKI among hospitalized patients with COVID-19 varies widely, recent studies from the US have suggested an incidence as high as 37-40%. [1][2][3] AKI among hospitalized patients is associated with poor prognosis, 4 increased length of stay, and increased health care costs. 5 Patients who survive AKI appear to be at an increased risk for death and incident chronic kidney disease (CKD).…”

Acute Kidney Injury during the COVID-19 Pandemic - Experience from Two Tertiary Centres in South Africa

“…(9-11) A recent systematic review and meta-analysis of 22 observational studies from China and the United States reported on renal complications in 17,391 hospitalized patients with COVID-19. The pooled incidence for AKI (n = 22 studies) was 11.0% (7.4-15.1) with 6.8% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) requiring kidney replacement therapy [KRT]. Although AKI was the common outcome reported by studies; hyperkalaemia was the most frequent renal complication with an incidence of 12.5%.…”

“…(4) The prevalence of AKI resulting in the need for KRT ranges from 0.8% in China to 20% of hospitalized patients in New York. (12,13) In a large New York cohort AKI was commonly seen in association with respiratory failure and mechanical ventilation. (10) Patients developing AKI in the setting of COVID-19 have poor outcomes, irrespective of their age.…”

“…(11) The worldwide mortality of AKI associated with COVID-19 has ranged from 22% to 100%. (10,11,(13)(14)(15)(16)) Zhou et al described a 100% mortality of those requiring acute KRT in a cohort from China. (16) Identified risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension [HPT] and need for mechanical ventilation and vasopressor support.…”