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Observational Study
. 2020 Jul;98(1):209-218.
doi: 10.1016/j.kint.2020.05.006. Epub 2020 May 16.

Acute kidney injury in patients hospitalized with COVID-19

Jamie S Hirsch  1 , Jia H Ng  2 , Daniel W Ross  2 , Purva Sharma  2 , Hitesh H Shah  2 , Richard L Barnett  2 , Azzour D Hazzan  2 , Steven Fishbane  2 , Kenar D Jhaveri  3 ; Northwell COVID-19 Research Consortium; Northwell Nephrology COVID-19 Research Consortium
Collaborators, Affiliations
Observational Study

Acute kidney injury in patients hospitalized with COVID-19

Jamie S Hirsch et al. Kidney Int. 2020 Jul.

Abstract

The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation. Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 694 died (35%), 519 (26%) were discharged and 780 (39%) were still hospitalized. AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis.

Keywords: AKI; COVID-19; continuous RRT; dialysis; renal failure.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Flowchart of the study. COVID-19, coronavirus disease 2019.
Figure 2
Figure 2
The number of patients with initial diagnosis of acute kidney injury, by hospital day of admission.
Figure 3
Figure 3
The probability of acute kidney injury diagnosis relative to time of mechanical ventilation.
Figure 4
Figure 4
The proportion of disposition type, by stages (1–3) of acute kidney injury (AKI).
Supplementary Figure S1
Supplementary Figure S1
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References

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