Incidence and Risk Factors for Acute Kidney Injury and Its Effect on Mortality in Patients Hospitalized From COVID-19

Abstract

Objective To determine the incidence of and risk-factors for development of acute kidney injury (AKI) and investigate the association between AKI and mortality in patients hospitalized with Covid-19. Patients and Methods This retrospective case series includes the first 370 patients consecutively hospitalized with confirmed Covid-19 illness between March 10, 2020 and May 13, 2020, at a 242-bed teaching hospital. To determine independent association between demographic factors, comorbidities and AKI incidence, multivariable-logistic regression models were used to estimate odds ratios adjusted for clinical covariates. Results Median age of patients was 71 (59–82) years and 44.3% were female. Patients with AKI were significantly older with a higher comorbidity-burden and mortality-rate (58.1% vs 19.6%, p<.001) when compared to those without AKI. Increasing age, chronic kidney disease, hyperlipidemia and being of African-American descent showed higher odds of AKI. Patients with AKI had significantly higher odds of mortality when compared to patients without AKI, and this effect was proportional to the stage of AKI. Increasing age and acute respiratory distress syndrome also revealed higher adjusted odds of mortality. Conclusion AKI is a common complication among hospitalized Covid-19 patients. We found significantly higher odds of AKI with increasing age, among hyperlipidemics and patients with chronic kidney disease and among African-Americans. We demonstrate an independent association between AKI and mortality with increasingly higher odds of mortality from progressively worsening renal failure in hospitalized Covid-19 patients.

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

“…Data from the America and England reported on the disparities in the risk and outcomes of COVID-19, with a higher risk in black people than white people [22,23]. Nimkar et al also demonstrated African-American race showed higher odds of AKI than the White [11]. However, our study indicated patients in White with COVID-19 had a signi cant increase in risk for AKI, whereas the pooled OR revealed a non-signi cant increase in Black.…”

“…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.…”

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

“…Published studies on AKI in COVID- 19 have thus far been hindered by relatively small sample sizes or incomplete clinical courses with patients still receiving treatment in the hospital. [7][8][9][10] As recovery from COVID-19, especially when severe, often takes weeks in the hospital, previously published studies may result in a skewed view of endpoints, potentially biasing toward adverse outcomes. [11][12][13] Additionally, prior publications have not addressed varied timelines of AKI development during hospitalization or the varied duration of follow-up.…”