High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy

Stevens, Jacob S.; King, Kristen L.; Robbins-Juarez, Shelief Y.; Khairallah, Pascale; Toma, Katherine; Verduzco, Hector Alvarado; Daniel, Emily; Douglas, D. J.; Moses, Andrew; Peleg, Yonatan; Starakiewicz, Piotr; Li, Miah T; Kim, Daniel W.; Yu, Kathleen; Qian, Long; Shah, Vaqar H.; O’Donnell, Max R; Cummings, Matthew J.; Zucker, Jason; Natarajan, Karthik; Perotte, Adler J.; Tsapepas, Demetra; Krzemieniecki, Krzysztof; Dube, Geoffrey K.; Siddall, Eric; Shirazian, Shayan; Nickolas, Thomas L.; Rao, Maya K.; Barasch, Jonathan; Valeri, Anthony M.; Radhakrishnan, Jai; Gharavi, Ali G.; Husain, S. Ali; Mohan, Sumit

doi:10.1371/journal.pone.0244131

Cited by 55 publications

(44 citation statements)

References 34 publications

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“…The rates of in-hospital AKI vary substantially among different series as well as rates of non-recovery of kidney function after convalescence [123,124]; however, given the numbers of patients surviving severe COVID-19, a surge of post-COVID-19 persistent kidney disease may occur. In a large study from Wuhan, 13% of patients without AKI and with normal estimated glomerular filtration rate (eGFR) at the acute phase had decreased eGFR at follow-up, necessitating postdischarge close monitoring of renal function [12].…”

Section: Renal Systemmentioning

confidence: 99%

Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review

Korompoki

Gavriatopoulou

Hicklen

et al. 2021

Journal of Infection

126

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Section: Renal Systemmentioning

confidence: 99%

Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review

Korompoki

Gavriatopoulou

Hicklen

et al. 2021

Journal of Infection

126

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“…COVID-19 is a respiratory illness that ranges in severity from mild upper respiratory symptoms to respiratory failure and death. Severe COVID-19 can cause multi-organ injury ( 2 , 3 ), and acute kidney injury (AKI) has emerged as a common complication of COVID-19 among hospitalized patients, affecting between 17 – 37% ( 4 , 5 , 6 , 7 , 8 , 9 ) and AKI is associated with a 9-fold increased risk of death during hospital stay ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury Incidence, Recovery, and Long-term Kidney Outcomes Among Hospitalized Patients With COVID-19 and Influenza

Strohbehn

Zhao

Seethapathy

et al. 2021

Kidney International Reports

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Introduction Acute kidney injury (AKI) is a common complication in patients with severe COVID-19. We sought to compare the AKI incidence and outcomes among patients hospitalized with COVID-19 and with influenza. Methods Retrospective cohort study of patients with COVID-19 hospitalized between March–May 2020 and historical controls hospitalized with influenza A or B between January 2017 and December 2019 within a large healthcare system. Cox proportional hazards models were used to compare the risk of AKI during hospitalization. Secondary outcomes included AKI recovery, mortality, new-onset chronic kidney disease (CKD) and ≥ 25% estimated glomerular filtration rate (eGFR) decline. Results A total of 2425 patients were included; 1091 (45%) had COVID-19 and 1334 (55%) had influenza. Overall AKI rate was 23% and 13% in patients with COVID-19 and influenza, respectively. Compared to influenza, hospitalized patients with COVID-19 had an increased risk of developing AKI (adjusted hazard ratio, aHR 1.58, 95% CI 1.29–1.94). Patients with AKI were more likely to die during hospital when infected with COVID-19 vs. influenza (aHR 3.55, 95% CI 2.11–5.97). Among patients surviving to hospital discharge, the rate of AKI recovery was lower in patients with COVID-19 (aHR 0.47, 95% CI 0.36–0.62); however, among patients followed for ≥ 90 days, new-onset CKD (aHR 1.24, 95% CI 0.86–1.78) and ≥ 25% eGFR decline at last follow-up (aHR 1.36, 95% CI 0.97–1.90) were not significantly different between the cohorts. Conclusion AKI and mortality rates are significantly higher in COVID-19 than influenza; however, kidney recovery among long-term survivors appears to be similar.

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“…Acute loss of kidney function, measured by a rise in serum creatinine (SCr), is common in the setting of acute SARS-CoV-2 infection [1][2][3][4] . Elevated SCr is present in one-third of patients hospitalized with COVID-19 [5][6][7][8][9][10][11] . Yet, SCr fails to represent the full burden of COVID-19 kidney injury, because it cannot diagnose early stages or subtotal kidney damage 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Urine Test Predicts Kidney Injury and Death in COVID-19

Menez

Moledina

Philbrook

et al. 2021

Preprint

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Background: Kidney injury is common in COVID-19 infection, but serum creatinine (SCr) is not a sensitive or specific marker of kidney injury. We hypothesized that molecular markers of tubular injury could diagnose COVID-19 associated kidney damage and predict its clinical course. Methods: This is a prospective cohort study of 444 consecutive COVID-19 patients (43.9% females, 20.5% African American, 54.1% Latinx) in Columbia University's Emergency Department at the peak of the New York pandemic (March-April 2020). Urine and blood were collected simultaneously at admission (median time of day 0, IQR 0-2 days) and within 1 day of a positive SARS-CoV-2 test in 70% of patients. Biomarker assays were blinded to clinical data. Results: Urinary NGAL (uNGAL) was strongly associated with AKI diagnosis (267±301 vs. 96±139 ng/mL, P=1.6x10-10). uNGAL >150ng/mL had 80% specificity and 75% sensitivity to diagnose AKIN stage 2 or higher. uNGAL quantitatively predicted the duration of AKI and outcomes, including death, dialysis, shock, and longer hospital stay. The risk of death increased 73% per standard deviation of uNGAL [OR (95%CI): 1.73 (1.29-2.33), P=2.8x10-4] and was independent of baseline SCr, co-morbidities, and proteinuria [adjusted OR (95%CI): 1.51 (1.10-2.11), P=1.2x10-2]. Proteinuria and uKIM-1 also indicated tubular injury, but were not diagnostic of AKI. Typically, distal nephron segments transcribe NGAL, but in COVID-19 biopsies with widespread acute tubular injury (ATI), NGAL expression overlapped KIM-1 in proximal tubules. Conclusion: uNGAL predicted the diagnosis, duration, and severity of AKI and ATI, as well as hospital stay, dialysis, shock, and death in patients with acute COVID-19.

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High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy

Cited by 55 publications

References 34 publications

Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review

Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review

Acute Kidney Injury Incidence, Recovery, and Long-term Kidney Outcomes Among Hospitalized Patients With COVID-19 and Influenza

Urine Test Predicts Kidney Injury and Death in COVID-19

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