Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications

Zahid, Umar; Ramachandran, Preethi; Spitalewitz, Samuel; Alasadi, Lutfi; Chakraborti, Abhishek; Azhar, Muhammad; Mikhalina, Galina; Sherazi, Andleeb; Narh, Joshua Tetteh; Khattar, Pallavi; Bedi, Puneet

doi:10.1159/000511160

Cited by 95 publications

(117 citation statements)

References 22 publications

(36 reference statements)

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“…Previous reports showed that kidney injury was associated with a poor prognosis among patients with COVID-19 [ 8 – 10 ]. A recent study involving 469 COVID-19 patients in USA revealed that AKI was an independent risk factor for in-hospital mortality [ 36 ]. A meta-analysis including 40 studies and 24,527 COVID-19 patients also demonstrated that AKI is associated with higher risk of mortality [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

et al. 2020

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Although the lungs are major targets for COVID-19 invasion, other organs—such as the kidneys—are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250–17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078–1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001–1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235–35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death.

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Section: Discussionmentioning

confidence: 99%

Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

et al. 2020

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“…, 2020 [ 177 ] Cohort study AKI 416 China 64 205M&211F 8 (1.92%) Zheng et al. 2020 [ 4 ] Retrospective AKI 555 China 52 269M&286F 29 (6%) Russo et al., 2020 [ 178 ] Retrospective AKI 777 Northern Italy 70 59%M&41%F 176 (22.6%) Zahid et al., 2020 [ 179 ] Retrospective cohort study AKI 469 USA 66 268M&201F 128 (27.3%) Richardson et al., 2020 [ 180 ] Case series AKI 2634 USA NA NA 523 (22.2%) Hong et al., 2020 [ 181 ] Retrospective AKI 98 South Korea 55.4 38M&60F 9 (9.2%) Cheruiyot et al. , 2020 [ 5 ] Systematic review & meta-analysis AKI 5832 - - - 1730 (29.66%) Fu et al., 2020 [ 182 ] Systematic review and meta-analysis AKI 49048 - - - 5152 (10.50%) Robbins-Juarez et al., 2020 [ 183 ] Systematic review and meta-analysis AKI 13137 - - - 2233 (17%) Lazzeri et al., 2...…”

Section: Introductionmentioning

confidence: 99%

Kidney diseases and COVID-19 infection: causes and effect, supportive therapeutics and nutritional perspectives

Askari

Sanadgol

Azarnezhad

et al. 2021

Heliyon

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Recently, the novel coronavirus disease 2019 , has attracted the attention of scientists where it has a high mortality rate among older adults and individuals suffering from chronic diseases, such as chronic kidney diseases (CKD). It is important to elucidate molecular mechanisms by which COVID-19 affects the kidneys and accordingly develop proper nutritional and pharmacological strategies. Although numerous studies have recently recommended several approaches for the management of COVID-19 in CKD, its impact on patients with renal diseases remains the biggest challenge worldwide. In this paper, we review the most recent evidence regarding causality, potential nutritional supplements, therapeutic options, and management of COVID-19 infection in vulnerable individuals and patients with CKD. To date, there is no effective treatment for COVID-19-induced kidney dysfunction, and current treatments are yet limited to anti-inflammatory (e.g. ibuprofen) and anti-viral medications (e.g. Remdesivir, and Chloroquine/Hydroxychloroquine) that may increase the chance of treatment. In conclusion, the knowledge about kidney damage in COVID-19 is very limited, and this review improves our ability to introduce novel approaches for future clinical trials for this contiguous disease.

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“…In some of these patients, even if they not diagnosed with AKI at admission, during the hospitalization they could be gradually worsened and diagnosed as AKI [10]. According to the recent literature, AKI incidence in hospitalized COVID-19 patients ranges from 8% to 22% [11].…”

Section: Discussionmentioning

confidence: 99%

Altered kidney function and acute kidney damage markers predict survival outcomes of COVID-19 patients: A prospective pilot study

Temiz

Hacıbey

Yazar

et al. 2021

Preprint

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BackgroundThe central role in the pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), called as coronavirus disease 2019 (COVID-19), infection is attributed to angiotensin-converting enzyme 2 (ACE-2). ACE-2 expressing respiratory system involvement is the main clinical manifestation of the infection. However, literature about the association between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and higher ACE-2 expressing kidney is very limited. In this study, we primarily aimed to investigate whether there is a kidney injury during the course of SARS-CoV-2 infection. The predictive value of kidney injury for survival was also determined.MethodsA total of 47 participants who met the inclusion criteria were included in the study. The participants were classified as ‘‘COVID-19 patients before treatment’’ ‘‘COVID-19 patients after treatment’’, ‘‘COVID-19 patients under treatment in ICU’’ and ‘‘controls’’. The parameters comorbidity, serum creatinine and cystatin C levels, CKD-EPI eGFR levels, KIM-1 and NGAL levels, urine KIM-1/creatinine and NGAL/creatinine ratios were statistically compared between the groups. The associations between covariates including kidney disease indicators and death from COVID-19 were examined using Cox proportional hazard regression analysis.ResultsSerum creatinine and cystatin C levels, urine KIM-1/creatinine levels, and CKD-EPI, CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C eGFR levels exhibited significant difference in the groups. The causes of the difference were more altered kidney function and increased acute kidney damage in COVID-19 patients before treatment and under treatment in ICU. Additionally, incidences of comorbidity and proteinuria in the urine analysis were higher in the COVID-19 patients under treatment in ICU group. Urine KIM-1/creatinine ratio and proteinuria were associated with COVID-19 specific death.ConclusionsWe found that COVID-19 patients under treatment in ICU exhibited extremely higher levels of serum cystatin C, and urine KIM-1/creatinine and urine NGAL/creatinine ratios. These results clearly described the acute kidney damage by COVID-19 using molecular kidney damage markers for the first time in the literature. Lowered CKD-EPI, CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C eGFR levels were determined in them, as well. Urine KIM-1/creatinine ratio and proteinuria were associated with COVID-19 specific death. In this regard, considering kidney function and kidney damage markers must not be ignored in the COVID-19 patients, and serial monitoring of them should be considered.

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Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications

Cited by 95 publications

References 22 publications

Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

Kidney diseases and COVID-19 infection: causes and effect, supportive therapeutics and nutritional perspectives

Altered kidney function and acute kidney damage markers predict survival outcomes of COVID-19 patients: A prospective pilot study

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