Characteristics and outcomes of hospitalised patients with acute kidney injury and COVID-19

Abstract

Introduction COVID-19 has spread globally to now be considered a pandemic by the World Health Organisation. Initially patients appeared to have a respiratory limited disease but there are now increasing reports of multiple organ involvement including renal disease in association with COVID-19. We studied the development and outcomes of acute kidney injury (AKI) in patients with COVID-19, in a large multicultural city hospital trust in the UK, to better understand the role renal disease has in the disease process. Methods This was a retrospective review using electronic records and laboratory data of adult patients admitted to the four Manchester University Foundation Trust Hospitals between March 10 and April 30 2020 with a diagnosis of COVID-19. Records were reviewed for baseline characteristics, medications, comorbidities, social deprivation index, observations, biochemistry and outcomes including mortality, admission to critical care, mechanical ventilation and the need for renal replacement therapy. Results There were 1032 patients included in the study of whom 210 (20.3%) had AKI in association with the diagnosis of COVID-19. The overall mortality with AKI was considerably higher at 52.4% compared to 26.3% without AKI (p-value <0.001). More patients with AKI required escalation to critical care (34.8% vs 11.2%, p-value <0.001). Following admission to critical care those with AKI were more likely to die (54.8% vs 25.0%, p-value <0.001) and more likely to require mechanical ventilation (86.3% vs 66.3%, p-value 0.006). Discussion We have shown that the development of AKI is associated with dramatically worse outcomes for patients, in both mortality and the requirement for critical care. Patients with COVID-19 presenting with, or at risk of AKI should be closely monitored and appropriately managed to prevent any decline in renal function, given the significant risk of deterioration and death.

Longitudinal Clinical Profiles of Hospital vs. Community-Acquired Acute Kidney Injury in COVID-19

“…Our ICU admission and mortality rate of patients with AKI are similar to previous studies (9)(10)(11)(12)(13)(14)(15). We found that the severity of AKI among patients with CA-AKI was similar to patients with HA-AKI.…”

“…Coronavirus disease 2019 (COVID-19) (1, 2) caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) is the worst public health disaster of the century, accounting for millions of infections and deaths globally. Hospital-acquired acute kidney injury (HA-AKI) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) is a frequent complication of COVID-19 that is associated with critical illness and increased mortality. Proposed mechanisms of AKI in patients with COVID-19 include volume depletion, hypotension, sepsis, cytokine storm, and direct viral-induced AKI, although the latter has not been proven (16).…”

AKI in Hospitalized Patients with COVID-19 and Seasonal Influenza: A Comparative Analysis

“…Kidney dysfunction in COVID-19 has been demonstrated to be an independent risk factor for mortality in hospitalized patients [8,9]. The emerging risk factors for AKI in COVID-19 (COV-AKI) include male gender, African American race, hypertension, diabetes mellitus, and congestive heart failure [2,7].…”

Acute Kidney Injury Due to COVID-19 in Intensive Care Unit: An Analysis From a Latin-American Center

“…Risk factors for AKI in critical patients with COVID-19 vary according to the population. Older age, male gender, black race, obesity, diabetes, hypertension, heart failure, chronic kidney disease, leukocytosis, anemia, lymphopenia, increase in levels of serum inflammatory markers (D-dimer, PCR, and IL-6), and need for mechanical ventilation and vasoactive drugs as well as the use of angiotensin-converting enzyme inhibitors were associated with a higher risk of AKI development in COVID-19 critical patients (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Herein, chronic kidney disease was more frequent in patients who developed AKI (18.5 vs. 14.6%), however with no statistical significance.…”