Abstract
BackgroundAcute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood.MethodsData was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset.ResultsOut of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p < 0.0001) while atrial fibrillation conferred a protective effect (adjusted odds ratio 0.29, p < 0.0209). Mortality was significantly higher for patients who had an AKI compared to those who didn’t have an AKI (54.3 % vs. 29.4 % respectively, p < 0.0001). On Cox regression, hospital-acquired AKI was significantly associated with mortality (adjusted hazard ratio 4.64, p < 0.0001) while community-acquired AKI was not.ConclusionsAKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.
Highlights
Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood
With regard to organ support, 13.8 % of patients were admitted to critical care, 14.1 % received non-invasive ventilation with or without invasive mechanical ventilation, and 11.6 % received invasive mechanical ventilation. 394 patients (87.9 %) had a positive COVID-19 swab within 14 days of hospital admission and were classified as community-acquired COVID-19 and 54 patients (12.1 %) had a positive COVID-19 swab after 14 days of hospital admission and were classified as hospitalacquired COVID-19
AKI patients were separated into 2 groups based on the timing of AKI onset relative to hospital admission: 57 patients had AKI onset within 48 h of hospital admission and were categorised as community-acquired AKI, and 61 patients had AKI onset after 48 h of hospital admission and were categorised as hospital-acquired AKI
Summary
Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood. It has been more than 12 months since the first reported case of coronavirus disease 2019 (COVID-19) from Wuhan, China. Histopathological case series describe acute tubular injury as the predominant finding with less frequent descriptions of thrombotic microangiopathy, cast nephropathy, and collapsing nephropathy [10,11,12,13,14,15]. The clinical factors driving these pathological findings are likely a combination of traditional risk factors for AKI, such as dehydration and predisposing comorbidities, alongside risk factors which may be more specific to COVID-19 disease. It is possible that the aetiological factors for AKI in COVID-19 will differ between community- and hospital-acquired AKI
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