The Incidence, Risk Factors, and Prognosis of Acute Kidney Injury in Adult Patients with Coronavirus Disease 2019

Cheng, Yuansheng; Luo, Ran; Wang, Xu; Wang, Kun; Zhang, Nanhui; Zhang, Meng; Wang, Zhixiang; Dong, Lei; Li, Junhua; Zeng, Rui; Yao, Ying; Ge, Shuwang; Xu, Gang

doi:10.2215/cjn.04650420

Cited by 106 publications

(125 citation statements)

References 30 publications

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“…Nevertheless, the burden of AKI in our GN patients is in the higher range of estimates. COVID-associated AKI portends a worse prognosis 21,22 and is associated with increased odds of death. 23 Among GN patients, those who developed AKI had higher serum creatinine at presentation compared to those without AKI and were more likely to have received IV steroids as part of the J o u r n a l P r e -p r o o f management of COVID-19.…”

Section: J O U R N a L P R E -P R O O F Discussionmentioning

confidence: 99%

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Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Waldman

Soler

García-Carro

et al. 2021

Kidney International

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The effects of SARS-CoV-2 infection on individuals with immune-mediated glomerulonephritis, who are often undergoing immunosuppressive treatments, are unknown. Therefore, we created the International Registry of COVID infection in glomerulonephritis (IRoc-GN) and identified 40 patients with glomerulonephritis and COVID-19 followed in centers in North America and Europe. Detailed information on glomerulonephritis diagnosis, kidney parameters, and baseline immunosuppression prior to infection were recorded, as well as clinical presentation, laboratory values, treatment, complications, and outcomes of COVID-19. This cohort was compared to 80 COVID-positive control cases from the general population without glomerulonephritis matched for the time of infection. The majority (70%) of the patients with glomerulonephritis and all the controls were hospitalized. Patients with glomerulonephritis had significantly higher mortality (15% vs. 5%, respectively) and acute kidney injury (39% vs. 14%) than controls, while the need for kidney replacement therapy was not statistically different between the two groups. Receiving immunosuppression or renin-angiotensin-aldosterone system inhibitors at presentation did not increase the risk of death or acute kidney injury in the glomerulonephritis cohort. In the cohort with glomerulonephritis, lower serum albumin at presentation and shorter duration of glomerular disease were associated with greater risk of acute kidney injury and need for kidney replacement therapy. No differences in outcomes occurred between patients with primary glomerulonephritis versus glomerulonephritis associated with a systemic autoimmune disease (lupus or vasculitis). Thus, due to the higher mortality and risk of acute kidney injury than in the general population without glomerulonephritis, patients with glomerulonephritis and COVID-19 should be carefully monitored, especially when they present with low serum albumin levels.

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Section: J O U R N a L P R E -P R O O F Discussionmentioning

confidence: 99%

“…Nevertheless, the burden of AKI in our GN patients is in the higher range of estimates. COVID-associated AKI portends a worse prognosis 20 , 21 and is associated with increased odds of death. 20 …”

Section: Discussionmentioning

confidence: 99%

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Waldman

Soler

García-Carro

et al. 2021

Kidney International

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“…There is some controversy in using baseline Cr (independent variable) as a risk factor for AKI (dependent variable) since the definition of AKI requires this variable. However, multiple previous studies have assessed the role of pre-illness Cr as a predictor of AKI [ 38 , 39 , 40 , 41 , 42 ]. Finally, because this is an observational study, no cause and effect relationship can be inferred.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil

et al. 2020

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Background: Critically ill patients with COVID-19 may develop multiple organ dysfunction syndrome, including acute kidney injury (AKI). We report the incidence, risk factors, associations, and outcomes of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients. Methods: We performed a retrospective cohort study of adult patients with COVID-19 diagnosis admitted to the intensive care unit (ICU) between March 2020 and May 2020. Multivariable logistic regression analysis was applied to identify risk factors for the development of AKI and use of RRT. The primary outcome was 60-day mortality after ICU admission. Results: 101 (50.2%) patients developed AKI (72% on the first day of invasive mechanical ventilation [IMV]), and thirty-four (17%) required RRT. Risk factors for AKI included higher baseline Cr (OR 2.50 [1.33–4.69], p = 0.005), diuretic use (OR 4.14 [1.27–13.49], p = 0.019), and IMV (OR 7.60 [1.37–42.05], p = 0.020). A higher C-reactive protein level was an additional risk factor for RRT (OR 2.12 [1.16–4.33], p = 0.023). Overall 60-day mortality was 14.4% {23.8% (n = 24) in the AKI group versus 5% (n = 5) in the non-AKI group (HR 2.79 [1.04–7.49], p = 0.040); and 35.3% (n = 12) in the RRT group versus 10.2% (n = 17) in the non-RRT group, respectively (HR 2.21 [1.01–4.85], p = 0.047)}. Conclusions: AKI was common among critically ill COVID-19 patients and occurred early in association with IMV. One in 6 AKI patients received RRT and 1 in 3 patients treated with RRT died in hospital. These findings provide important prognostic information for clinicians caring for these patients.

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“…Most studies evaluating rates of AKI from China are from single hospitals, with a range of 52–1392 patients for a period of 2–9 weeks [ 8 , 12 – 23 ] (Table 1 ). Reported rates of AKI vary between 0.5–50% [ 8 , 12 , 23 , 32 ]. The heterogeneity in rates may be attributable to different definitions for AKI, variable cohort size, and inclusion of patients from different care settings (e.g., all hospitalized vs intensive care unit).…”

Section: Main Textmentioning

confidence: 99%

The COVID-19 nephrology compendium: AKI, CKD, ESKD and transplantation

et al. 2020

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The pandemic of coronavirus disease 2019 (CoVID-19) has been an unprecedented period. The disease afflicts multiple organ systems, with acute kidney injury (AKI) a major complication in seriously ill patients. The incidence of AKI in patients with CoVID-19 is variable across numerous international studies, but the high incidence of AKI and its associated worse outcomes in the critical care setting are a consistent finding. A multitude of patterns and mechanisms of AKI have been elucidated, and novel strategies to address shortage of renal replacement therapy equipment have been implemented. The disease also has had consequences on longitudinal management of patients with chronic kidney disease and end stage kidney disease. Kidney transplant recipients may be especially susceptible to CoVID-19 as a result of immunosuppression, with preliminary studies demonstrating high mortality rates. Increased surveillance of disease with low threshold for testing and adjustment of immunosuppression regimen during acute periods of illness have been recommended.

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The Incidence, Risk Factors, and Prognosis of Acute Kidney Injury in Adult Patients with Coronavirus Disease 2019

Cited by 106 publications

References 30 publications

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil

The COVID-19 nephrology compendium: AKI, CKD, ESKD and transplantation

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