Fatal Outcomes of COVID-19 in Patients with Severe Acute Kidney Injury

Abstract

The outcome of coronavirus disease 2019 (COVID-19) is associated with organ damage; however, the information about the relationship between acute kidney injury (AKI) and COVID-19 is still rare. We evaluated the clinical features and prognosis of COVID-19 patients with AKI according to the AKI severity. Medical data of hospitalized COVID-19 patients in two university-based hospitals during an outbreak in Daegu, South Korea, were retrospectively analyzed. AKI and its severity were defined according to the Acute Kidney Injury Network. Of the 164 hospitalized patients with COVID-19, 30 patients (18.3%) had AKI; 14, 4, and 12 patients had stage 1, 2, and 3, respectively. The median age was significantly higher in AKI patients than in non-AKI patients (75.5 vs. 67.0 years, p = 0.005). There were 17 deaths (56.7%) among AKI patients; 4 (28.6%), 1 (25.0%), and 12 (100.0%), respectively. In-hospital mortality was higher in AKI patients than in non-AKI patients (56.7% vs. 20.8%, p < 0.001). After adjusting for potential confounding factors, stage 3 AKI was associated with higher mortality than either non-AKI or stage 1 AKI (hazard ratio (HR) = 3.62 (95% confidence interval (CI) = 1.75–7.48), p = 0.001; HR = 15.65 (95% CI = 2.43–100.64), p = 0.004). Among the AKI patients, acute respiratory distress syndrome and low serum albumin on admission were considered independent risk factors for stage 3 AKI (both p < 0.05). Five patients with stage 3 AKI underwent dialysis and eventually died. In conclusion, COVID-19 patients with severe AKI had fatal outcomes.

Acute kidney injury in hospitalized patients with COVID-19

“…39 Lim et al studied 164 hospitalized patients with an AKI incidence of 18% and demonstrated that AKI KDIGO stage 3 was independently associated with mortality. 40 This is also consistent with the results of our cohort, as we reported an increased risk of mortality with the severity of AKI (adjusted OR 2.30 per increase in KDIGO stage (95% CI 1.10-4.82), p=0.027). Consistent with previous data we reported an increased risk of mortality associated with older age, lower hemoglobin and acidemia.…”

“…1 The rate of mortality in hospitalized patients ranges from 10-30% and is much higher in critically ill patients. 9,12,[35][36][37] Cheng et al demonstrated that renal dysfunction de ned as either elevated baseline SCr, hematuria, proteinuria and AKI, was associated with mortality in a prospective cohort of 701 hospitalized patients with COVID-19. 38 Despite reporting an incidence of AKI of only 5.1%, this study reported a higher risk of mortality according to AKI severity.…”

Kidney function on admission predicts in-hospital mortality in COVID-19

“…evaluated the characteristics of deceased COVID-19 patients and found that AKI was more frequent in patients who died (25%) when compared to those who survived (1%) [16]. In another study, Pei et al reported that 6% of their patients experienced AKI [18], while Lim et al found that the median age was higher in AKI patients [24]. Moreover, Lim et al reported the highest rate of mortality in COVID-19 patients with AKI.…”

Adverse impact of renin-angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study

“…Severe COVID-19 was associated with multiple organ injuries such as ARDS [25][26][27] and AKI [28][29][30] , which were identi ed as independent risk factors for mortality in patients with COVID-19. However, the association of ACE-I or ARB use with AKI or ARDS is still not fully understood.…”

“…This study was conducted as a retrospective cohort study that analyzed all patients with COVID-19 who were admitted to 2 university-based tertiary hospitals in Daegu, South Korea (Kyungpook National University Hospital and Kyungpook National University Chilgok Hospital). COVID-19 was con rmed based on nasopharyngeal and oropharyngeal swab samples using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) for SARS-CoV-2 28 . At the time of initial diagnosis, COVID-19 patients were classi ed into 4 categories (mild, moderate, severe, and critical) using the Telephone Severity Scoring System according to age, symptoms, underlying diseases, and social factors 37 .…”