Characteristics of Acute Kidney Injury in Hospitalized COVID-19 Patients in an Urban Academic Medical Center

Abstract

AKI is a recognized complication of coronavirus disease 2019 (COVID-19) (1). In this study, we characterized the AKI incidence and outcomes in patients with COVID-19 and AKI. We conducted a retrospective cohort study of 1002 patients admitted from March 1 to April 19, 2020 through the Emergency Department at NewYork-Presbyterian/ Weill Cornell Medical Center. Patient follow-up was until at least June 20, 2020, at which time 22 patients were still hospitalized and nine were transferred to another hospital facility. Baseline creatinine was defined as the closest creatinine prior to March 1, 2020 or, if none was available, the creatinine at time of hospital presentation. The Weill Cornell Institutional Review Board approved this study. AKI, defined by the Kidney Disease Improving Global Outcomes criteria (2), occurred in 294 (29%) of the 1002 patients: stage 1 AKI (n5182, 18%); stage 2 AKI (n529, 3%); and stage 3 AKI (n583, 8%). KRT was performed in 59 patients (6%); 53 received hemodialysis and/or continuous venovenous hemodialysis, five received a combination of acute peritoneal dialysis and hemodialysis/continuous venovenous hemodialysis, and one received acute peritoneal dialysis. The time from hospitalization to AKI was a median of 2.2 days in stage 1 AKI, 2.4 days in stage 2 AKI, and 1.6 days in stage 3 AKI. We evaluated the urine electrolytes and microscopy associated with the AKI event within 3 days. Among those available, the fractional excretion of sodium (FENa) was ,1% in 76%, and urine microscopy had granular casts in 21%. The presumed etiology of stage 3 AKI on the basis of manual chart review was acute tubular necrosis (ATN) in 28%, prerenal in 13%, prerenal/ATN in 11%, other causes in 4%, and unknown in 45% of patients. Granular casts were observed more frequently in stage 3 AKI than stage 1 AKI and stage 2 AKI (33% versus 16%, P50.006). We compared clinical characteristics of the patients with AKI with those without AKI (Table 1). Patients who developed AKI were older and more frequently had a history of hypertension, diabetes mellitus, congestive heart failure, CKD, and kidney transplantation than patients without AKI (P,0.001). Proteinuria and hematuria were

The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis

“…Twenty one reports were from the United States, 7 , 8 , 10 , 19 , 20 , 21 , 22 , 26 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 17 reports were from China, 11 , 12 , 25 , 28 , 30 , 33 , 34 , 35 , 36 , 37 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 12 from Europe 18 , 29 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , one each from India 67 , Bahrain 68 and South Korea 27 , and one report 69 included multiple cities from the United States and Europe. The studies included 30,657 hospitalized patients, of whom 12,800 (41.8%) were women.…”

Risk Factors for Acute Kidney Injury in Patients with Coronavirus Disease 2019 (COVID-19): A Meta-Analysis

“…Finally, 11 studies (6, 9-18) with 8815 patients with COVID-19 ful lled eligibility criteria (Fig 1). Table 1 presents the summary characteristics of the 11 included studies [6,[9][10][11][12][13][14][15][16][17][18]. The prevalence of AKI ranged from 10.3% to 81%.…”

“…The prevalence of AKI ranged from 10.3% to 81%. Ten studies [6,[9][10][11][12][13][14][16][17][18] were single center, and one [15] was multicenter.…”

“…Eight studies [6, 9-13, 15, 17] used retrospective cohorts, two [14,18] were observational studies, and one [16] was a cohort trial. Studies were conducted in China [9,10,13,15], United States [6,11,17,18], France [12,16], and Australia [14]. We assessed the risk of bias of the studies included in the qualitative review based on Newcastle-Ottawa Scale criteria.…”

COVID‐19 infection in former living kidney donors

“…Not surprisingly, these questions are being raised by prospective donors especially given the evidence of risk among individuals with reduced kidney function. [6][7][8][9] The living donor evaluation includes extensive medical testing prior to donation resulting in a donor pool with relatively few comorbidities, if any, and therefore, former donors should not be at higher risk for severe infection than general population.…”