Abstract
ABSTRACTBackgroundAcute kidney injury (AKI) is common in coronavirus disease 2019 (COVID-19). This study investigated adults hospitalized with COVID-19 and hypothesized that risk factors for AKI would include comorbidities and non-White race.MethodsA prospective multicentre cohort study was performed using patients admitted to 254 UK hospitals with COVID-19 between 17 January 2020 and 5 December 2020.ResultsOf 85 687 patients, 2198 (2.6%) received acute kidney replacement therapy (KRT). Of 41 294 patients with biochemistry data, 13 000 (31.5%) had biochemical AKI: 8562 stage 1 (65.9%), 2609 stage 2 (20.1%) and 1829 stage 3 (14.1%). The main risk factors for KRT were chronic kidney disease (CKD) [adjusted odds ratio (aOR) 3.41: 95% confidence interval 3.06–3.81], male sex (aOR 2.43: 2.18–2.71) and Black race (aOR 2.17: 1.79–2.63). The main risk factors for biochemical AKI were admission respiratory rate >30 breaths per minute (aOR 1.68: 1.56–1.81), CKD (aOR 1.66: 1.57–1.76) and Black race (aOR 1.44: 1.28–1.61). There was a gradated rise in the risk of 28-day mortality by increasing severity of AKI: stage 1 aOR 1.58 (1.49–1.67), stage 2 aOR 2.41 (2.20–2.64), stage 3 aOR 3.50 (3.14–3.91) and KRT aOR 3.06 (2.75–3.39). AKI rates peaked in April 2020 and the subsequent fall in rates could not be explained by the use of dexamethasone or remdesivir.ConclusionsAKI is common in adults hospitalized with COVID-19 and it is associated with a heightened risk of mortality. Although the rates of AKI have fallen from the early months of the pandemic, high-risk patients should have their kidney function and fluid status monitored closely.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a major impact on global health
acute kidney injury (AKI) is common in adults hospitalised with COVID-19 and it is associated with a heightened risk of mortality
Acute kidney injury is the commonest complication in COVID-19 and it is associated with an increased risk of mortality
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a major impact on global health. COVID-19 produces primarily pulmonary damage (acute respiratory distress syndrome – ARDS), acute kidney injury (AKI) is common,[1] ranging from minor biochemical changes in serum creatinine to requirement for kidney replacement therapy (KRT: dialysis or haemofiltration). RIPT As infection rates accelerated in New York in March 2020, there were reports of AKI in 37% of hospitalised patients[2 3 4], substantially higher than reports from China (
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