Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 28;14(6):1557-1569.
doi: 10.1093/ckj/sfab021. eCollection 2021 Jun.

Acute kidney injury in 3182 patients admitted with COVID-19: a single-center, retrospective, case-control study

Fabio L Procaccini  1 , Roberto Alcázar Arroyo  1 , Marta Albalate Ramón  1 , Esther Torres Aguilera  1 , Juan Martín Navarro  1 , Pablo Ryan Murua  2 , Melissa Cintra Cabrera  1 , Mayra Ortega Díaz  1 , Marta Puerta Carretero  1 , Patricia de Sequera Ortiz  1
Affiliations

Acute kidney injury in 3182 patients admitted with COVID-19: a single-center, retrospective, case-control study

Fabio L Procaccini et al. Clin Kidney J. .

Abstract

Background: Acute kidney injury (AKI) may develop in coronavirus disease 2019 (COVID-19) patients and may be associated with a worse outcome. The aim of this study is to describe AKI incidence during the first 45 days of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Spain, its reversibility and the association with mortality.

Methods: This was an observational retrospective case-control study based on patients hospitalized between 1 March and 15 April 2020 with SARS-CoV-2 infection and AKI. Confirmed AKI cases were compared with stable kidney function patients for baseline characteristics, analytical data, treatment and renal outcome. Patients with end-stage kidney disease were excluded.

Results: AKI incidence was 17.22% among 3182 admitted COVID-19 patients and acute kidney disease (AKD) incidence was 6.82%. The most frequent causes of AKI were prerenal (68.8%) and sepsis (21.9%). Odds ratio (OR) for AKI was increased in patients with pre-existent hypertension [OR 2.58, 95% confidence interval (CI) 1.71-3.89] and chronic kidney disease (CKD) (OR 2.14, 95% CI 1.33-3.42) and in those with respiratory distress (OR 2.37, 95% CI 1.52-3.70). Low arterial pressure at admission increased the risk for Stage 3 AKI (OR 1.65, 95% CI 1.09-2.50). Baseline kidney function was not recovered in 45.73% of overall AKI cases and in 52.75% of AKI patients with prior CKD. Mortality was 38.5% compared with 13.4% of the overall sample population. AKI increased mortality risk at any time of hospitalization (hazard ratio 1.45, 95% CI 1.09-1.93).

Conclusions: AKI is frequent in COVID-19 patients and is associated with mortality, independently of acute respiratory distress syndrome. AKD was also frequent and merits adequate follow-up.

Keywords: COVID-19; acute kidney disease; acute kidney injury; case–control; chronic kidney disease; mortality.

PubMed Disclaimer

Figures

None
Graphical abstract
FIGURE 1:
FIGURE 1:
Cumulative incidence and 7 days average of patients admitted at Hospital Universitario Infanta Leonor with suspected COVID-19 between 1 March and 15 April 2020.
FIGURE 2:
FIGURE 2:
Flowchart of cases and controls selection. Patients with sCr <1.3 mg/dL were not actively revised to confirm COVID-19 criteria. Eligible controls were randomly sampled to obtain a control group of the same size of cases group. All patients in case and control group were actively revised to confirm COVID-19 criteria.
FIGURE 3:
FIGURE 3:
AKI resolution was defined as return to baseline value of sCr. For CKD patients, a value >25% from baseline at the end of follow-up was considered as no resolution.
FIGURE 4:
FIGURE 4:
AKI resolution occurred with higher probability and earlier in patients with normal kidney function or low-stage CKD.
FIGURE 5:
FIGURE 5:
Kaplan–Meier survival curve. Patients with concomitant AKI and ARDS are less likely to survive than patients who presented only one of these conditions. AKI demonstrates its role as a major risk factor for mortality.
FIGURE 6:
FIGURE 6:
Distribution of AKI resolution, AKD and exitus at the end of follow-up.
See this image and copyright information in PMC

References

    1. Guan W-J, Ni Z-y, Hu Y. et al. China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708–1720 - PMC - PubMed
    1. Cheng Y, Luo R, Wang K. et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020; 97: 829–838 - PMC - PubMed
    1. Hamming I, Timens W, Bulthuis ML. et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203: 631–637 - PMC - PubMed
    1. Hoffmann M, Kleine-Weber H, Schroeder S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181: 271–280.e8 - PMC - PubMed
    1. Pan XW, Xu D, Zhang H. et al. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med 2020; 46: 1114–1116 - PMC - PubMed