AKI in Hospitalized Patients with COVID-19.

Jagat Narula, Girish N Nadkarni, Steven G Coca, Benjamin S Glicksberg, Erwin P Böttinger, Alexander W Charney, John C He, Barbara Murphy, Valentin Fuster, David L Reich, Matthew A Levin, Eric Schadt, Carlos Cordon-Cardo, Zahi Fayad, Carol Horowitz, Allan C Just, Lili Chan, Rong Chen, Robert Freeman, Li Li, Prem Timsina, Arash Kia, Anuradha Lala, Riccardo Miotto, Felix Richter, Sulaiman Somani, Ishan Paranjpe, Shan Zhao, Akhil Vaid, Kinsuk Chauhan, Aparna Saha, Kumardeep Chaudhary

Journal: Journal of the American Society of Nephrology : JASN 2021;32(1):151-160

PMID: 32883700

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Abstract

BACKGROUND

Early reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described.

METHODS

This retrospective, observational study involved a review of data from electronic health records of patients aged ≥18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality.

RESULTS

Of 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up.

CONCLUSIONS

AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.

Address: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.; BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.; The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York.; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York.; Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York.; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York.; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York.; The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.; Digital Health Center, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany.

DOI: 10.1681/ASN.2020050615

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MeSH Terms: Acute Kidney Injury, Aged, Aged, 80 and over, COVID-19, Female, Hematuria, Hospital Mortality, Hospitals, Private, Hospitals, Urban, Humans, Incidence, Inpatients, Leukocytes, Male, Middle Aged, New York City, Proteinuria, Renal Dialysis, Retrospective Studies, SARS-CoV-2, Treatment Outcome, Urine