European Primary Care Cardiovascular Society

High incidence of acute kidney injury in COVID-19 patients

Acute kidney injury in patients hospitalized with COVID-19

Literature - Hirsch JS, Ng JH, Ross DW et al., - Kidney Int. 2020. doi:10.1016/j.kint.2020.05.006

Introduction and methods

Initial reports found a rate of acute kidney injury (AKI) in patients with COVID-19 ranging from 0.5% to 29% [1-10]. Little is known about AKI in COVID-19 beyond rate. This observative study took place in 13 hospitals in and around New York City and investigated the rate of AKI among patients hospitalized with COVID-19. Moreover, aspects of the phenomenology (such as descriptions of timing, laboratory findings from urine samples, and risk factors) were described for this patient population.

Data from 5449 patients who were admitted between March 1, 2020 and April 5, 2020, for COVID-19 were included in this analysis. Patients younger than 18 years old, with a kidney transplant or with end stage kidney disease were excluded. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria (stage 1: increase in serum creatinine by 0.3 mg/dl within 48 hours or a 1.5-1.9× increase in serum creatinine from baseline within 7 days, stage 2: 2.9× increase in serum creatinine within 7 days, stage 3: 3× or more increase in serum creatinine within 7 days or initiation of renal replacement therapy [RRT]).

The primary outcome was development of AKI. Other outcomes were need for RRT and hospital disposition. Patients were followed up through April 12, 2020.

Main results

Conclusion

This observational study in 13 hospitals in and around New York City found that 36.6% of patients hospitalized with COVID-19 developed AKI during hospitalization. Development of AKI was linked to requirement of mechanical ventilation. Among those who required ventilation and developed AKI, onset of AKI often occurred within 24h of intubation.

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