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Acute kidney injury in patients hospitalized with COVID-19

      The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation. Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 694 died (35%), 519 (26%) were discharged and 780 (39%) were still hospitalized. AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis.

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      Linked Article

      • Thrombotic microangiopathy in a patient with COVID-19
        Kidney InternationalVol. 98Issue 2
        • Preview
          We describe a patient with coronavirus disease 2019 (COVID-19) and clinically significant kidney biopsy-proven thrombotic microangiopathy.
        • Full-Text
        • PDF
      • Time-dependent effect, immortal bias, and competing risk: 3 components that should be handled to assess the impact of covariates on occurrence of acute kidney injury
        Kidney InternationalVol. 98Issue 5
        • Preview
          We read with great interest the study from Hirsch et al. in the July 2020 issue of Kidney International.1 In that study, the authors aimed to identify risk factors of acute kidney injury (AKI) in patients admitted for coronavirus disease 2019. They compared characteristics of 5449 patients according to AKI occurrence and performed multivariable logistic regression to adjust for covariates. The authors have identified 2 risk factors occurring during the hospital stay: the need for mechanical ventilation (odds ratio = 31.6 [25.8–38.6] in univariate analysis and odds ratio = 10.7 [6.81–16.7] in multivariable analysis) and vasopressor medication (odds ratio = 31.4 [25.6–38.4] in univariate analysis and odds ratio = 4.5 [2.9–7.1] in multivariable analysis).
        • Full-Text
        • PDF
      • The authors reply
        Kidney InternationalVol. 98Issue 5
        • Preview
          We thank Jamme and Geri for their comments.1 When we first embarked on this study in mid-April 2020, the data on acute kidney injury (AKI) among patients hospitalized with coronavirus disease 2019 in the United States were sparse.2 Thus, our primary research question was to (i) determine the rates of AKI among these patients, and (ii) investigate the effects of potential explanatory variables on the occurrence of AKI.2 The goal was not to determine time-to-AKI, nor to make causal inferences about how mechanical ventilation causes AKI.
        • Full-Text
        • PDF