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Observational Study
. 2020 May 13;1(7):614-622.
doi: 10.34067/KID.0002652020. eCollection 2020 Jul 30.

Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans

Muner M B Mohamed  1 , Ivo Lukitsch  1 , Aldo E Torres-Ortiz  1 , Joseph B Walker  2 , Vipin Varghese  2 , Cesar F Hernandez-Arroyo  1 , Muhannad Alqudsi  1 , Jason R LeDoux  1 , Juan Carlos Q Velez  1   2
Affiliations
Observational Study

Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans

Muner M B Mohamed et al. Kidney360. .

Abstract

Background: AKI is a manifestation of COVID-19 (CoV-AKI). However, there is paucity of data from the United States, particularly from a predominantly black population. We report the phenotype and outcomes of AKI at an academic hospital in New Orleans.

Methods: We conducted an observational study in patients hospitalized at Ochsner Medical Center over a 1-month period with COVID-19 and diagnosis of AKI (KDIGO). We examined the rates of RRT and in-hospital mortality as outcome measures.

Results: Among 575 admissions (70% black) with COVID-19 [173 (30%) to an intensive care unit (ICU)], we found 161 (28%) cases of AKI (61% ICU and 14% general ward admissions). Patients were predominantly men (62%) and hypertensive (83%). Median body mass index (BMI) was higher among those with AKI (34 versus 31 kg/m2, P<0.0001). AKI over preexisting CKD occurred in 35%. Median follow-up was 25 (1-45) days. The in-hospital mortality rate for the AKI cohort was 50%. Vasopressors and/or mechanical ventilation were required in 105 (65%) of those with AKI. RRT was required in 89 (55%) patients. Those with AKI requiring RRT (AKI-RRT) had higher median BMI (35 versus 33 kg/m2, P=0.05) and younger age (61 versus 68, P=0.0003). Initial values of ferritin, C-reactive protein, procalcitonin, and lactate dehydrogenase were higher among those with AKI; and among them, values were higher for those with AKI-RRT. Ischemic acute tubular injury (ATI) and rhabdomyolysis accounted for 66% and 7% of causes, respectively. In 13%, no obvious cause of AKI was identified aside from COVID-19 diagnosis.

Conclusions: CoV-AKI is associated with high rates of RRT and death. Higher BMI and inflammatory marker levels are associated with AKI as well as with AKI-RRT. Hemodynamic instability leading to ischemic ATI is the predominant cause of AKI in this setting.

Keywords: COVID-19; ICU; New Orleans; SARS; SARS-CoV-2; United States; acute kidney injury; acute kidney injury and ICU nephrology; black; dialysis; hospital mortality; obesity; phenotype; proteinuria; renal replacement therapy.

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Conflict of interest statement

J.C. Velez has participated in Advisory Board engagements with Mallinckrodt Pharmaceuticals and Retrophin, and has been a member of a Speaker Bureau for Otsuka Pharmaceuticals. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flow chart illustrating the identification of patients admitted to either the intensive care unit (ICU) or the general ward of the hospital with a diagnosis of coronavirus disease 2019 (COVID-19), who presented with or developed AKI during the first 10 days of hospitalization, indicating the proportion of patients who needed RRT or died.
Figure 2.
Figure 2.
Proportion of patients requiring RRT depending on type of AKI (de novo versus AKI superimposed over preexisting CKD) or bed location (ICU versus general ward).
Figure 3.
Figure 3.
Baseline demographic variables that revealed differences between patients with AKI who required RRT and those who did not. Age (A–C) and body mass index (BMI) (D–F) ranges are shown for the entire cohort, for those who presented with de novo AKI, and for those with AKI superimposed over preexisting CKD.
Figure 4.
Figure 4.
Baseline blood laboratory values revealed differences between patients with AKI who required RRT and those who did not. Serum ferritin values (A–C) for the entire cohort, for those who presented with de novo AKI, and for those with AKI superimposed over preexisting CKD are shown. C-reactive protein (CRP) (D), procalcitonin (E), and lactate dehydrogenase (LDH) (F) values for the entire cohort are shown.
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Comment in

  • 588–590

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