Acute Kidney Injury in COVID-19: The Chinese Experience

Abstract

Coronavirus disease 2019 (COVID-19) is spreading rapidly worldwide. Here, we review recently published studies on COVID-19-associated acute kidney injury (AKI) in China. The pooled incidence of AKI in all reported COVID-19 patients was 6.5%, with a much higher rate in patients from the intensive care unit (32.5%). AKI is associated with the severity of COVID-19 and mortality rates, which is similar to other kidney abnormalities including proteinuria and hematuria. The renal tubule is the main site of injury in COVID-19 patients, and the etiology of renal impairment in COVID-19 patients likely is diverse and multifactorial. Apart from direct viral attack via angiotensin-converting enzyme 2 and transmembrane serine proteases 2, hypoxia and hypercoagulability also may contribute to the occurrence of renal injury. To date, there is only randomized controlled trial evidence to support the use of dexamethasone in patients requiring oxygen therapy and remdesivir for shortening the time to recovery, with no specific treatment for COVID-19-associated AKI. Studies researching kidney pathologies or reporting renal outcome and prognosis are in urgent need. Further studies are urgently warranted to identify risk factors, to predict prognosis and renal outcome, to explore the exact mechanisms of renal injury, and to suggest targeted interventions.

Keywords: COVID-19; China; acute kidney injury; incidence; management.

Figure 1

AKI incidence in COVID-19 patients in China. Studies are subgrouped by (A) settings and (B) regions. Abbreviation: CI, confidence interval.

Figure 2

Timeline of admission, occurrence of critical illness, onset of in-hospital acute kidney injury (AKI), and death from onset of symptom. The median time was 5 days (25% to 75% percentile, 3-11) for admission (n = 555), 13 days (25% to 75% percentile, 8-17) for critical illness (n = 75), 18 days (25% to 75% percentile, 14-22) for in-hospital AKI (n = 21), and 29 days (25% to 75% percentile, 22-38) for death (n = 27). Data adapted with permission from Zheng et al.

Figure 3

Patient screening and disposition for coronavirus disease 2019 (COVID-19) in hemodialysis settings. ^aSuspicious symptoms include fever, cough, sore throat, chest pain, shortness of breath, fatigue, headache, conjunctivitis, and muscle soreness. ^bDialysis in general isolation should be the last shift of the day in a separate treatment room. ^cDialysis in enhanced isolation should be the last additional shift after daily routine treatment. Adapted with permission from the Chinese Journal of Blood Purification.