COVID-19–Associated Acute Kidney Injury

Siew, Edward D.; Birkelo, Bethany C.

doi:10.2215/cjn.13600820

Cited by 7 publications

(11 citation statements)

References 9 publications

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“…AKI is associated with 1.7 and 3.81 times increased hazard for developing CKD and end-stage kidney disease [37], and 79% of RRT patients did not recover 6 months after discharge, as reported in previous studies [38]. In our cohort, patients who developed in-hospital AKI had a trend of persistent GFR reduction after 24 weeks of discharge when compared to patients who did not have AKI, which is consistent with the Wuhan cohort (32% non-recoverable at discharge) [17,39]. As 1-year interval was previously shown to divide the hazard of mortality [12], adequate provision of renal follow-up service within the first 12 months would be critical to reduce the intermediateterm increase in mortality.…”

Section: Long-term Renal Involvement After Covid-19supporting

confidence: 90%

“…The median hospitalization duration was 18 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] days (Table 1). The median age was 38.4 [28.4-55.8] years.…”

Section: Demographicsmentioning

confidence: 99%

“…In all, 3.7 and 0.7% of the patients had AKI and RRT during hospitalization (Table 2); 4.6% of all patients were admitted to intensive care unit. The median time from symptom onset and admission to reaching peak SCr was 15 [10][11][12][13][14][15][16][17][18] and 5 [5][6][7][8][9][10][11][12] days, respectively, among patients who developed AKI. AKI developed 2 [1][2][3][4][5][6][7] days after admission.…”

Section: Renal and Other Key Clinical Outcomesmentioning

confidence: 99%

“…The incidence of AKI was lower and earlier in COVID-19 (3.7%) than in SARS (6.4%) [24,25]. For COVID-19, the median time to develop AKI after admission was 2 [1][2][3][4][5][6][7] days, and the median time from symptom onset and admission to reaching peak SCr were 15 [10][11][12][13][14][15][16][17][18] and 5 [5][6][7][8][9][10][11][12] days, whereas the median time from the onset of viral infection to AKI was 20 days in SARS [24]. In our cohort, SCr reached the peak (median: 15 days) following LDH (median: 9 days) among patients who developed AKI.…”

Section: Clinical Implication -Prolonged Hospitalization and Disease mentioning

confidence: 99%

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Mass Screening Is Associated with Low Rates of Acute Kidney Injury among COVID-19 Patients in Hong Kong

et al. 2021

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Introduction: Renal involvement in COVID-19 is less well characterized in settings with vigilant public health surveillance, including mass screening and early hospitalization. We assessed kidney complications among COVID-19 patients in Hong Kong, including the association with risk factors, length of hospitalization, critical presentation, and mortality. Methods: Linked electronic records of all patients with confirmed COVID-19 from 5 major designated hospitals were extracted. Duplicated records due to interhospital transferal were removed. Primary outcome was the incidence of in-hospital acute kidney injury (AKI). Secondary outcomes were AKI-associated mortality, incident renal replacement therapy (RRT), intensive care admission, prolonged hospitalization and disease course (defined as >90th percentile of hospitalization duration [35 days] and duration from symptom onset to discharge [43 days], respectively), and change of estimated glomerular filtration rate (GFR). Patients were further stratified into being symptomatic or asymptomatic. Results: Patients were characterized by young age (median: 38.4, IQR: 28.4–55.8 years) and short time (median: 5, IQR: 2–9 days) from symptom onset to admission. Among the 591 patients, 22 (3.72%) developed AKI and 4 (0.68%) required RRT. The median time from symptom onset to in-hospital AKI was 15 days. AKI increased the odds of prolonged hospitalization and disease course by 2.0- and 3.5-folds, respectively. Estimated GFR 24 weeks post-discharge reduced by 7.51 and 1.06 mL/min/1.73 m2 versus baseline (upon admission) in the AKI and non-AKI groups, respectively. The incidence of AKI was comparable between asymptomatic (4.8%, n = 3/62) and symptomatic (3.7%, n = 19/519) patients. Conclusion: The overall rate of AKI among COVID-19 patients in Hong Kong is low, which could be attributable to a vigilant screening program and early hospitalization. Among patients who developed in-hospital AKI, the duration of hospitalization is prolonged and kidney function impairment can persist for up to 6 months post-discharge. Mass surveillance for COVID-19 is warranted in identifying asymptomatic subjects for earlier AKI management.

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Section: Long-term Renal Involvement After Covid-19supporting

confidence: 90%

“…The median hospitalization duration was 18 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] days (Table 1). The median age was 38.4 [28.4-55.8] years.…”

Section: Demographicsmentioning

confidence: 99%

Section: Renal and Other Key Clinical Outcomesmentioning

confidence: 99%

Section: Clinical Implication -Prolonged Hospitalization and Disease mentioning

confidence: 99%

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Mass Screening Is Associated with Low Rates of Acute Kidney Injury among COVID-19 Patients in Hong Kong

et al. 2021

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“…Incidence of AKI in patients with COVID-19 varies greatly among reports from different geographic locations [ 9 , 10 , 11 , 12 , 13 , 14 ]. Heterogeneity in the definition of AKI complicates this discussion even further.…”

Section: Epidemiology Of Cov-akimentioning

confidence: 99%

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

Sanchez-Russo

Billah

Chancay

et al. 2021

JCM

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Acute kidney injury (AKI) is a common finding in patients with coronavirus disease 2019 (COVID-19) and has been associated with higher rates of death when compared to COVID-19 patients without kidney injury. Whereas the definitive pathogenesis of COVID-19-related AKI (CoV-AKI) is not clear, histopathologic evidence seems to point at multiple etiologies for the disease, including indirect and direct viral kidney injury. The high incidence of CoV-AKI, along with the aggressive clinical presentation of this entity, have increased the demands for kidney replacement therapies, rapidly overwhelming the supplies of healthcare systems even in major tertiary care centers. As a result, nephrologists have come up with alternatives to maximize the efficiency of treatments and have developed non-conventional therapeutic alternatives such as the implementation of acute peritoneal dialysis for critically ill patients. The long-term implications of CoV-AKI are yet unknown, though early studies suggest that around one third of the patients who survive will remain dependent on kidney replacement therapy. Nephrologists and healthcare workers need to be familiar with the clinical presentation and therapeutic challenges of CoV-AKI in order to develop strategies to mitigate the burden of the disease for patients, and for services providing kidney replacement therapies.

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Critical Illness and Systemic Inflammation Are Key Risk Factors of Severe Acute Kidney Injury in Patients With COVID-19

Hardenberg

Stockmann

Aigner

et al. 2021

Kidney International Reports

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Introduction Acute kidney injury (AKI) is an important complication in COVID-19, but its precise etiology has not fully been elucidated. Insights into AKI mechanisms may be provided by analyzing the temporal associations of clinical parameters reflecting disease processes and AKI development. Methods We performed an observational cohort study of 223 consecutive COVID-19 patients treated at 3 sites of a tertiary care referral center to describe the evolvement of severe AKI (Kidney Disease: Improving Global Outcomes stage 3) and identify conditions promoting its development. Descriptive statistics and explanatory multivariable Cox regression modeling with clinical parameters as time-varying covariates were used to identify risk factors of severe AKI. Results Severe AKI developed in 70 of 223 patients (31%) with COVID-19, of which 95.7% required kidney replacement therapy. Patients with severe AKI were older, predominantly male, had more comorbidities, and displayed excess mortality. Severe AKI occurred exclusively in intensive care unit patients, and 97.3% of the patients developing severe AKI had respiratory failure. Mechanical ventilation, vasopressor therapy, and inflammatory markers (serum procalcitonin levels and leucocyte count) were independent time-varying risk factors of severe AKI. Increasing inflammatory markers displayed a close temporal association with the development of severe AKI. Sensitivity analysis on risk factors of AKI stage 2 and 3 combined confirmed these findings. Conclusion Severe AKI in COVID-19 was tightly coupled with critical illness and systemic inflammation and was not observed in milder disease courses. These findings suggest that traditional systemic AKI mechanisms rather than kidney-specific processes contribute to severe AKI in COVID-19.

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COVID-19–Associated Acute Kidney Injury

Cited by 7 publications

References 9 publications

Mass Screening Is Associated with Low Rates of Acute Kidney Injury among COVID-19 Patients in Hong Kong

Mass Screening Is Associated with Low Rates of Acute Kidney Injury among COVID-19 Patients in Hong Kong

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

Critical Illness and Systemic Inflammation Are Key Risk Factors of Severe Acute Kidney Injury in Patients With COVID-19

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