Abstract
Renal involvement is frequent in COVID-19 (4–37%). This study evaluated the incidence and risk factors of acute kidney injury (AKI) in hospitalized patients with COVID-19.Methodology: This study represents a prospective cohort in a public and tertiary university hospital in São Paulo, Brazil, during the first 90 days of the COVID-19 pandemic, with patients followed up until the clinical outcome (discharge or death).Results: There were 101 patients hospitalized with COVID-19, of which 51.9% were admitted to the intensive care unit (ICU). The overall AKI incidence was 50%; 36.8% had hematuria or proteinuria (66.6% of those with AKI), 10.2% had rhabdomyolysis, and mortality was 36.6%. Of the ICU patients, AKI occurred in 77.3% and the mortality was 65.4%. The mean time for the AKI diagnosis was 6 ± 2 days, and Kidney Disease Improving Global Outcomes (KDIGO) stage 3 AKI was the most frequent (58.9%). Acute renal replacement therapy was indicated in 61.5% of patients. The factors associated with AKI were obesity [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.04–2.76, p < 0.05] and the APACHE II score (OR 1.97, 95% CI 1.08–2.64, p < 0.05). Mortality was higher in the elderly (OR 1.03, 95% CI 1.01–1.66, p < 0.05), in those with the highest APACHE II score (OR 1.08, 95% CI 1.02–1.98, p < 0.05), and in the presence of KDIGO stage 3 AKI (OR 1.11, 95% CI 1.05–2.57, p < 0.05).Conclusion: AKI associated with severe COVID-19 in this Brazilian cohort was more frequent than Chinese, European, and North American data, and the risk factors associated with its development were obesity and higher APACHE II scores. Mortality was high, mainly in elderly patients, in those with a more severe disease manifestation, and in those who developed KDIGO stage 3 AKI.
Highlights
In December 2019, an outbreak of unexplained pneumonia cases was reported in the city of Wuhan, China
Latin American data are scarce; the objective of this study was to evaluate the incidence of acute kidney injury (AKI) in hospitalized patients diagnosed with COVID-19 and to identify both the risk factors associated with its onset and those associated with its prognosis during the first 90 days of the pandemic in a Brazilian public and tertiary university hospital
When we evaluated only patients submitted to acute renal replacement therapy, the standard timing for initiation occurred in 15 patients (60%), and early indication based on the presence of AKI stage 1 or 2 and cytokine storm or cumulative positive water balance higher than 3% of weight occurred in 10 patients (40%)
Summary
In December 2019, an outbreak of unexplained pneumonia cases was reported in the city of Wuhan, China. The pathogen was identified as a new strain of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) [1, 2]. The clinical spectrum of COVID-19 is broad and, diffuse alveolar damage and acute respiratory failure are the main characteristics of the disease in its severe form, renal involvement is frequent, especially among critically ill patients (20–40%), and is a factor related to worse outcomes [3, 4]. Latin American data are scarce; the objective of this study was to evaluate the incidence of acute kidney injury (AKI) in hospitalized patients diagnosed with COVID-19 and to identify both the risk factors associated with its onset and those associated with its prognosis during the first 90 days of the pandemic in a Brazilian public and tertiary university hospital
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