Acute kidney injury in COVID‐19: Identification of risk factors and potential biomarkers of disease in a large UK cohort

Abstract

Background COVID‐19 is associated with increased risk of acute kidney injury (AKI). Risk factors and biomarkers linked to AKI have now been recognized by national guidelines in the United Kingdom. This analysis aims to validate and expand the comorbidities and biomarkers associated with the presence and severity of AKI in these patients. Methods Data were extracted via structured query language for patients with COVID‐19 at University Hospital Southampton between 1 March and 10 June 2020. Demographics, comorbidities, common biomarkers and AKI stage within 48 hours of admission, peak during admission and the last measurement prior to patient outcome (discharge or death) were collected and statistically analysed. Results Six hundred and thirty‐two COVID‐19 positive patients were admitted during this period; 34.2% had an AKI during their entire admission, 20.3% had AKI stage 1, 8.5% stage 2 and 5.4% stage 3. This was higher when compared with data from the same period in 2019. AKI carried an increased risk of death, 50.0% vs 21.1% (P = <.001). AKI stage was significantly associated with age over 65, diabetes, heart failure, peripheral vascular disease, haematological malignancy, hypertension, respiratory rate, albumin, C‐reactive protein (CRP), d‐dimer, ferritin, high‐sensitivity troponin‐I, neutrophil count, total white cell counts, National Early Warning Score‐2 (NEWS‐2), Charlson comorbidity index and alanine‐aminotransferase. COVID‐19 specific treatment, including dexamethasone, reduced discharge creatinine. Conclusion COVID‐19 increases the risk of AKI and this kidney injury may be responsive to treatment. This analysis identified that AKI is associated with both previously described and new comorbidities and biomarkers.

The Frequency and Risk Factors for Acute Kidney Injury in patients with COVID-19

“…COVID-19 patients who are older, males, malnourished or diabetic are more prone to develop AKI. 15 In current study, patients with higher age had AKI more than patients with relatively lower age as also reported by other studies. 10,13,15 This may be due to immunocompromised elderly people are more likely to develop COVID-19 often along with an atypical presentation and complications making diagnosis and management difficult.…”

“…15 In current study, patients with higher age had AKI more than patients with relatively lower age as also reported by other studies. 10,13,15 This may be due to immunocompromised elderly people are more likely to develop COVID-19 often along with an atypical presentation and complications making diagnosis and management difficult. 16 Apart from COVID-19, age related structural and functional changes in kidneys leading to reduced renal mass, functioning nephron number and baseline kidney function along with increased likelihood of dehydration, reno-vascular occlusion and impairment of renal auto-regulation also make elderly people highly vulnerable to AKI.…”

“…In present study, DM came out to be a significant risk factor for developing AKI as reported by other studies. 10,13,15 In a study by Khalili et al 18 , amongst hospitalized COVID-19 patients, AKI developed more in diabetics as compared to non-diabetics (62% vs. 38%). Hyperglycemia, suppressed immunity, thromboembolic events and sepsis/septic shock are important pathogenic mechanisms involved in causing AKI in DM.…”

Acute kidney injury in moderate and severe COVID‑19 patients: Report of two university hospitals

“…Several studies have reported that inflammatory markers in COVID-19 are predictive both for the occurrence and severity of AKI (15)(16)(17)(18). Severe lung injury is associated with the overproduction of pro-inflammatory cytokines which can increase the risk of AKI (19), as was documented, at least experimentally, even before the COVID-19 pandemic (20).…”

Overview of acute kidney manifestations and management of patients with COVID-19

“…Biomarkers of systemic inflammation, including IL-6, C-reactive protein (CRP), D-dimer, and ferritin, have been associated with severe COVID-19 infection in general as well as with severe AKI ( 35 ). Husain-Syed et al ( 36 ) were the first to report on the association of urinary biomarkers beyond proteinuria and hematuria with AKI in patients with COVID-19.…”