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. 2020 Aug 1;35(8):1353-1361.
doi: 10.1093/ndt/gfaa189.

Chronic kidney disease and acute kidney injury in the COVID-19 Spanish outbreak

Jose Portolés  1   2 , María Marques  1   2 , Paula López-Sánchez  1 , María de Valdenebro  1   2 , Elena Muñez  3 , María Luisa Serrano  1 , Rosa Malo  4 , Estefanya García  1   2 , Valentín Cuervas  3
Affiliations

Chronic kidney disease and acute kidney injury in the COVID-19 Spanish outbreak

Jose Portolés et al. Nephrol Dial Transplant. .

Abstract

Background: Novel coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread, affecting >10 million cases worldwide. Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and primarily manifesting as an acute respiratory failure with interstitial and alveolar pneumonia, it can also affect multiple organs. Kidney involvement was underestimated in early reports and its role remains controversial. The aim of this study was to analyse the role of kidney damage in COVID-19 outcome.

Methods: This is a prospective cohort study of 1603 consecutive patients admitted in a University Reference Hospital in the heart of the European outbreak.

Results: Median age was 64 years, 40.4% were female, 15.2% presented diabetes mellitus, 35.7% hypertension and 20.3% obesity. On admission, the prevalence of elevated serum creatinine (sCr), proteinuria, leucocyturia and haematuria were 21.0, 37.8, 31.8 and 45.6%, respectively. In total, 43.5% of those with an elevated sCr had previous chronic kidney disease (CKD) and 11.4% of those with normal sCr developed an in-hospital acute kidney injury (AKI); 17 patients needed acute haemodialysis; and 197 patients died during hospitalization. Cox proportional hazard regression confirmed that elevated baseline sCr [hazard ratio (95% confidence interval) 2.40 (1.79-3.22)], previous CKD [1.59 (1.06-2.37)], haematuria [1 + 1.68 (0.92-3.06), 2-3 + 2.69 (1.49-4.87)] and in-hospital AKI [1.50 (0.92-2.44)] were independent risk factors for in-hospital death after adjusting for age, sex and comorbidity.

Conclusion: The prevalence of acute and chronic kidney disease on admission and in-hospital AKI is higher than previously reported in Wuhan, and is associated with high in-hospital mortality. We should increase our awareness towards kidney involvement and design specific strategies for management of COVID-19 in these patients.

Keywords: COVID-19; SARS-CoV-2; acute kidney injury; chronic kidney disease; outcomes.

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Figures

FIGURE 1
FIGURE 1
Patient flow chart. Normal values for sCr adjusted by sex. CKD defined as eGFR by CKD-EPI <60 mL/min/1.73 m2. AKI definition according to KDIGO.
FIGURE 2
FIGURE 2
Kaplan–Meier analysis of cumulative incidence for in-hospital death of patients with COVID-19 disease. Criteria by: (A) baseline sCr, (B) peak sCr, (C) baseline BUN, (D) haematuria (0, 1+, 2+ to 3+), (E) previous CKD versus normal sCr, (F) AKI anytime versus sCr normal.
See this image and copyright information in PMC

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