Abstract
BackgroundKidney disease accompanying coronavirus disease 2019 (COVID-19) is not well understood, and information about the presentation of acute kidney injury (AKI), its risk factors, and outcomes is scarce, particularly in Bahrain and the Gulf region. In this study, we aimed to determine the rate of AKI among patients hospitalized with COVID-19 pneumonia at a tertiary hospital in Bahrain and to describe the various aspects of AKI in these patients, including its relationship with respiratory failure and in-hospital mortality.MethodsThis retrospective observational cohort study of patients admitted with COVID-19 pneumonia from April 1 to May 31, 2020, excluded those aged less than 18 years, those with end-stage renal disease, and those with renal transplants. Clinical and laboratory patient data were collected. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI.ResultsThe mean age across the 73 included patients was approximately 54 years; about 60% were men, and nearly 58% were Bahraini nationals. Of the patients, 39.7% (29) developed AKI during hospitalization, out of which 11.0% reached stage 1, 15.1% reached stage 2, and 13.7% reached stage 3. Of all patients, seven (9.6%) required hemodialysis. Chronic kidney disease conferred an increased risk for AKI (P = 0.003) as did critical COVID-19 status (P < 0.001) and the necessity for mechanical ventilation or intensive care admission (P < 0.001 for both). Additionally, AKI was significantly associated with a lower PaO2/FiO2 (partial pressure of arterial oxygen/percentage of inspired oxygen) ratio (P < 0.001) and a greater number of medications for COVID-19 pneumonia (P = 0.003). Finally, in-hospital death tolls were remarkably higher in patients with AKI (P < 0.001). No association was found between AKI and each of the following therapies: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, tocilizumab, and convalescent plasma.ConclusionsThe rate of AKI in patients hospitalized with COVID-19 pneumonia at our institution is relatively high and is strongly associated with disease severity, respiratory failure, and in-hospital mortality. Awareness of kidney disease in COVID-19 patients is crucial and of vital importance.
Highlights
In December 2019, a novel coronavirus was recognized as the source of a series of cases of acute respiratory illness in Wuhan, a city in the Hubei Province of China
acute kidney injury (AKI) was significantly associated with a lower PaO2/FiO2 ratio (P < 0.001) and a greater number of medications for COVID-19 pneumonia (P = 0.003)
No association was found between AKI and each of the following therapies: angiotensinconverting enzyme inhibitors or angiotensin receptor blockers, tocilizumab, and convalescent plasma
Summary
In December 2019, a novel coronavirus was recognized as the source of a series of cases of acute respiratory illness in Wuhan, a city in the Hubei Province of China. It spread rapidly, resulting in a global pandemic in which at least 15 million confirmed cases and more than 640,000 deaths were reported as of July 25, 2020 [1]. Kidney disease accompanying coronavirus disease 2019 (COVID-19) is not well understood, and information about the presentation of acute kidney injury (AKI), its risk factors, and outcomes is scarce, in Bahrain and the Gulf region. We aimed to determine the rate of AKI among patients hospitalized with COVID-19 pneumonia at a tertiary hospital in Bahrain and to describe the various aspects of AKI in these patients, including its relationship with respiratory failure and in-hospital mortality
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