Abstract
BackgroundAcute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre.MethodsWe analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020.ResultsOf the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24–4,18; p < 0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27–2.53; p < 0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19–2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82–4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17–4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months.ConclusionsThis large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3–6 months.
Highlights
Since its emergence in December 2019, Coronavirus disease-2019 (COVID-19) caused by the newly recognised severe acute respiratory syndrome coronavirus-2019 (SARS-CoV-2), has affected millions of individuals worldwide, with considerable morbidity and mortality
The presence of Acute kidney injury (AKI) is associated with higher mortality risk in the context of acute respiratory distress syndrome (ARDS) of all aetiologies [8] and, causality is not established, AKI has been linked to an increased risk of chronic kidney disease (CKD) in individuals with previously normal renal function [9]
The study was performed in accordance with the principles of the Declaration of Helsinki and under London South East Research Ethics Committee approval granted to the King’s Electronic Records Research Interface (KERRI); specific work on COVID19 research was reviewed in March 2020 and reaffirmed in April 2020 with expert patient input on a virtual committee with Caldicott Guardian oversight
Summary
Since its emergence in December 2019, Coronavirus disease-2019 (COVID-19) caused by the newly recognised severe acute respiratory syndrome coronavirus-2019 (SARS-CoV-2), has affected millions of individuals worldwide, with considerable morbidity and mortality. Despite initial reports of low incidence [1,2,3,4], acute kidney injury (AKI) in patients hospitalised with COVID-19 has Jewell et al BMC Nephrol (2021) 22:359 been recognised as an important disease complication. In light of potential short- and long-term implications, it is important to understand the epidemiology of all AKI stages in patients with COVID-19 globally and locally and identify potential risk factors. These findings may provide meaningful insight, with regards to resource allocation, clinical management and research planning during the phases of the pandemic. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre
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