Two Phenotypes of Acute Kidney Injury Among Patients with COVID-19: A Multicenter Study from Wuhan, China

Abstract

Background: Acute kidney injury (AKI) is an important complication of Coronavirus disease 2019 (COVID-19), which could be caused by both systematic responses for multi-organ dysfunction and direct virus infection. While advanced evidence is needed regarding its clinical features and mechanisms. We aimed to describe two phenotypes of AKI, as well as their risk factors and the association with mortality. Methods: Consecutive hospitalized patients with COVID-19 of three hospitals in Wuhan, China, from January 2020 to March 2020 were included. Patients with AKI were classified as AKI-early and AKI-late according to the sequence of organ dysfunction (kidney as the first dysfunctional organ or not). Demographic and clinical features were compared between two AKI groups. Their risk factors and the associations with in-hospital mortality were analyzed. Findings: A total of 4020 cases with laboratory-confirmed COVID-19 were included, and 285(7·09%) of them were identified as AKI. Compared with patients with AKI-early, patients with AKI-late had significantly higher levels of systemic inflammatory markers. Both AKIs were associated with increased risks of in-hospital mortality, with similar fully adjusted HRs of 2·46 (95% confidence interval [CI] 1·35 - 4·49) for AKI-early and 3·09(95% CI 2·17 - 4·40) for AKI-late. Only hypertension was independently associated with the risk of AKI-early, while age, history of chronic kidney disease, and the levels of inflammatory biomarkers were associated with the risk of AKI-late. Interpretation: AKI among patients with COVID-19 has two clinical phenotypes, which could be due to different mechanisms. Considering the increased risk for mortality for both phenotypes, monitoring for AKI should be emphasized during the COVID-19. Funding: Special Research Fund of PKU for Prevention and Control of COVID-19; the Fundamental Research Funds for the Central Universities; the National Natural Science Foundation of China; Major Research Plan of the National Natural Science Foundation of ChinaDeclaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the National Health Commission of China and the institutional review board (IRB) of Peking University Health Science Centre(IRB00001052-20032).