Early versus late acute kidney injury among patients with COVID-19—a multicenter study from Wuhan, China

Peng, Shuanghe; Wang, Huaiyu; Sun, Xiaoyu; Li, Pengfei; Ye, Zhanghui; Li, Qing; Wang, Jinwei; Shi, Xuanyu; Liu, Liu; Yao, Ying; Zeng, Rui; He, Fan; Li, Junhua; Ge, Shuwang; Ke, Xianjun; Zhou, Zhi‐Bin; Dong, Erdan; Wang, Haibo; Xu, Gang; Zhang, Luxia; Zhao, Ming

doi:10.1093/ndt/gfaa288

Cited by 32 publications

(36 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Data on the outcome of AKI in COVID-19 patients with baseline pre-dialysis CKD are sparse [ 35 , 37 ]. Patients with COVID-19 plus CKD and AKI had a higher mortality rate compared to those with only AKI or CKD (74.7% vs .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology

et al. 2021

View full text Add to dashboard Cite

Background Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality. Conclusions Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Peng et al . reported that AKI diagnosis before the onset date of any other organ dysfunction (AKI-early) was less frequent in patients with CKD [ 37 ]. In our study, the frequency of CKD stage 3, 4, and 5 non-dialysis was 25.3%, 12.3%, and 5.1%, respectively, among the patients with AKI.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology

et al. 2021

View full text Add to dashboard Cite

show abstract

“…While initial studies from China reported a lower incidence (7.09%), a recent systematic analysis on 30 639 hospitalized patients, across all age groups with COVID19 reported the pooled prevalence of AKI as 28% and that for KRT as 9%. This figure was higher (46% for AKI, 19% for KRT) in critically ill patients requiring ICU admission [ 15 , 16 ]. Data from the pediatric population are rather limited and variable.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Hospitalized Children with COVID19

Chopra

Saha

Kumar

et al. 2021

Journal of Tropical Pediatrics

View full text Add to dashboard Cite

Background Acute kidney injury (AKI) has been recognized as a significant risk factor for mortality among adults with severe acute respiratory syndrome coronavirus infection. Aim The aim of this study is to assess the prevalence and risk factors for AKI and mortality in children with coronavirus disease 2019 (COVID19) from a resource-limited setting. Methods Cross-sectional analysis of laboratory confirmed COVID19 children admitted from 1 March to 30 November 2020 in a tertiary care hospital in New Delhi, India was done. Clinical features and associated comorbidities of COVID19 were noted. Baseline serum creatinine (height-independent Hoste’s equation) and peak serum creatinine were used for staging of AKI by the 2012 Kidney Disease Improving Global Outcomes serum creatinine criteria. Univariate analysis and Kaplan–Meier survival analysis were used to compare the overall outcome in the AKI vs. the non-AKI group. Results A total of 64 810 children between 1 month and 18 years visited the hospital; 3412 were tested for suspected COVID19, 295 tested positive and 105 (54% boys) were hospitalized. Twenty-four hospitalized children (22.8%) developed AKI; 8 in Stage 1 (33.3%), 7 in Stage 2 (29.2%) and 9 in Stage 3 (37.5%) respectively. Overall, three patients received KRT. Highest reported mortality was (66.6%) in AKI Stage 3. Risk factors for AKI included associated sepsis (OR 95% CI, 1.22-9.43, p < 0.01), nephrotic syndrome (OR 95% CI, 1.13-115.5, p < 0.01), vasopressor support (OR 3.59, 95% CI, 1.37–9.40, p value< 0.007), shock at presentation (OR 2.98, 95% CI, 1.16–7.60, p value 0.01) and mechanical ventilation (OR 2.64, 95% CI, 1.04–6.71, p value< 0.03). Mortality (25.71%) was higher in the AKI group (OR 95% CI, 1.14-8.35, p < 0.023) with shock (OR 45.92; 95% CI, 3.44–612.0, p value <0.004) and ventilation (OR 46.24; 95% CI, 1.6–1333.0 p value< 0.02) as significant risk factors for mortality. Conclusion AKI is an important modifiable risk factor for mortality in children with COVID19 in a resource-limited setting. Our study supports the strengthening of kidney replacement therapy and its timely initiation to reduce the progression of AKI and thus mortality in children.

show abstract

“…The reported incidence and severity of AKI in the setting of COVID-19 depends on the clinical setting and definitions used. Most studies have used the Kidney Disease Improving Global Outcomes (KDIGO) consensus definition of AKI and several studies that have used this definition have reported that upwards of 30–50% of hospitalized patients with COVID-19 develop some form of AKI, with the proportion increasing in those requiring intensive care 3 , 7 , 9 , 12 , 13 . According to one meta-analysis from 2020, the pooled incidence of AKI among hospitalized patients with COVID-19 was 28.6% (95% CI 19.8–39.5) in the USA and Europe and 5.5% (95% CI 4.1–7.4) in China 16 .…”

Section: Features Of Covid-19 Akimentioning

confidence: 99%

“…Both early and late forms of AKI (that is, AKI at presentation and AKI developing after presentation) were associated with an increased risk of in-hospital mortality. Moreover, CKD, older age and levels of inflammatory biomarkers were associated with an increased risk of late AKI 13 . In another study of 1,603 patients consecutively admitted to a university reference hospital in Spain, 21.0% of patients demonstrated elevated serum creatinine levels at admission, of whom 43.5% had previous CKD; 11.4% of patients with normal serum creatinine level at admission developed AKI 14 .…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of COVID-19-associated acute kidney injury

et al. 2021

View full text Add to dashboard Cite

Although respiratory failure and hypoxaemia are the main manifestations of COVID-19, kidney involvement is also common. Available evidence supports a number of potential pathophysiological pathways through which acute kidney injury (AKI) can develop in the context of SARS-CoV-2 infection. Histopathological findings have highlighted both similarities and differences between AKI in patients with COVID-19 and in those with AKI in non-COVID-related sepsis. Acute tubular injury is common, although it is often mild, despite markedly reduced kidney function. Systemic haemodynamic instability very likely contributes to tubular injury. Despite descriptions of COVID-19 as a cytokine storm syndrome, levels of circulating cytokines are often lower in patients with COVID-19 than in patients with acute respiratory distress syndrome with causes other than COVID-19. Tissue inflammation and local immune cell infiltration have been repeatedly observed and might have a critical role in kidney injury, as might endothelial injury and microvascular thrombi. Findings of high viral load in patients who have died with AKI suggest a contribution of viral invasion in the kidneys, although the issue of renal tropism remains controversial. An impaired type I interferon response has also been reported in patients with severe COVID-19. In light of these observations, the potential pathophysiological mechanisms of COVID-19-associated AKI may provide insights into therapeutic strategies.

show abstract

Early versus late acute kidney injury among patients with COVID-19—a multicenter study from Wuhan, China

Cited by 32 publications

References 45 publications

Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology

Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology

Acute Kidney Injury in Hospitalized Children with COVID19

Pathophysiology of COVID-19-associated acute kidney injury

Contact Info

Product

Resources

About