Clinical characteristics and factors associated with acute kidney injury among patients hospitalized with coronavirus disease
an observational retrospective study
Keywords:
Acute kidney injury, COVID-19, Community-acquired infections, Mortality, Risk factorsAbstract
BACKGROUND: Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE: To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING: Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS: We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS: The patients’ age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. the factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION: AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.
Downloads
References
Nadim MK, Forni LG, Mehta RL, et al. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrol. 2020;16(12):747-64. PMID: 33060844; https://doi.org/10.1038/s41581-020-00356-5.
Batlle D, Soler MJ, Sparks MA, et al. Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology. J Am Soc Nephrol. 2020;31(7):1380-3. PMID: 32366514; https://doi.org/10.1681/ASN.2020040419.
Lin L, Wang X, Ren J, et al. Risk factors and prognosis for COVID-19-induced acute kidney injury: a meta-analysis. BMJ Open. 2020;10(11):e042573. PMID: 33172950; https://doi.org/10.1136/bmjopen-2020-042573.
Rivero J, Merino-López M, Olmedo R, et al. Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19). Clin J Am Soc Nephrol. 2021;16(5):685-93. PMID: 33782033; https://doi.org/10.2215/CJN.16281020.
Su H, Yang M, Wan C, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020;98(1):219-27. PMID: 32327202; https://doi.org/10.1016/j.kint.2020.04.003.
Santoriello D, Khairallah P, Bomback AS, et al. Postmortem Kidney Pathology Findings in Patients with COVID-19. J Am Soc Nephrol. 2020;31(9):2158-67. PMID: 32727719; https://doi.org/10.1681/ASN.2020050744.
Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-18. PMID: 32416116; https://doi.org/10.1016/j.kint.2020.05.006.
Shao M, Li X, Liu F, et al. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res. 2020;161:105107. PMID: 32739424; https://doi.org/10.1016/j.phrs.2020.105107.
Martínez-Rueda AJ, Álvarez RD, Méndez-Pérez RA, et al. Community- and Hospital-Acquired Acute Kidney Injury in COVID-19: Different Phenotypes and Dismal Prognosis. Blood Purif. 2021:50(6):931-41. PMID: 33744901; https://doi.org/10.1159/000513948.
Work Group Membership. Kidney Int Suppl (2011). 2012;2(1):2. PMID: 25028631; https://doi.org/10.1038/kisup.2012.2.
Chawla LS, Bellomo R, Bihorac A, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13(4):241-57. PMID: 28239173; https://doi.org/10.1038/nrneph.2017.2.
Chen YT, Shao SC, Hsu CK, et al. Incidence of acute kidney injury in COVID-19 infection: a systematic review and meta-analysis. Crit Care. 2020;24(1):346. PMID: 32546191; https://doi.org/10.1186/s13054-020-03009-y.
Chan L, Chaudhary K, Saha A, et al. AKI in Hospitalized Patients with COVID-19. J Am Soc Nephrol. 2021;32(1):151-60. PMID: 32883700; https://doi.org/10.1681/ASN.2020050615.
Pelayo J, Lo KB, Bhargav R, et al. Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System. Cardiorenal Med. 2020;10(4):223-31. PMID: 32554965; https://doi.org/10.1159/000509182.
Hansrivijit P, Qian C, Boonpheng B, et al. Incidence of acute kidney injury and its association with mortality in patients with COVID-19: a meta-analysis. J Investig Med. 2020;68(7):1261-70. PMID: 32655013; https://doi.org/10.1136/jim-2020-001407.
Hamilton P, Hanumapura P, Castelino L, et al. Characteristics and outcomes of hospitalised patients with acute kidney injury and COVID-19. PLoS One. 2020;15(11):e0241544. PMID: 33141867; https://doi.org/10.1371/journal.pone.0241544.
