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1. Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology.

Author

Arikan, Hakki, Ozturk, Savas, Tokgoz, Bulent, Dursun, Belda, Seyahi, Nurhan, Trabulus, Sinan, Islam, Mahmud, Ayar, Yavuz, Gorgulu, Numan, Karadag, Serhat, Gok, Mahmut, Akcali, Esra, Bora, Feyza, Aydın, Zeki, Altun, Eda, Ahbap, Elbis, Polat, Mehmet, Soypacacı, Zeki, Oguz, Ebru Gok, and Koyuncu, Sumeyra

Subjects
ACUTE kidney failure, COVID-19, HOSPITAL patients, KIDNEYS, CHRONIC kidney failure, HOSPITAL mortality
Abstract

Background: Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods: In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results: The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality. Conclusions: Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged. [ABSTRACT FROM AUTHOR]

Published
2021
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2. Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology

Author

Ebru Gok Oguz, Gulsah Boz, Feyza Bora, Numan Gorgulu, Mahmut Gok, Enver Yuksel, Serhat Karadag, Dilek Guven Taymez, Dilek Gibyeli Genek, Ekrem Kara, Eda Altun, Serhan Tuglular, Sultan Ozkurt, Melike Betul Ogutmen, Zeki Aydin, Elbis Ahbap, Belda Dursun, Zeki Soypacaci, Mehmet Polat, İdris Şahin, Mahmud Islam, Savas Ozturk, Sinan Trabulus, Murside Esra Dolarslan, Erkan Sengul, Esra Akcali, Hamad Dheir, Nurhan Seyahi, Elif Ari Bakir, Ozgur Akin Oto, Hakki Arikan, Tuncay Sahutoglu, Yavuz Ayar, Özant Helvacı, Zehra Eren, Ilhan Kurultak, Sumeyra Koyuncu, Bulent Tokgoz, Hulya Colak, ALKÜ, Fakülteler, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Arikan, Hakki, Ozturk, Savas, Tokgoz, Bulent, Dursun, Belda, Seyahi, Nurhan, Trabulus, Sinan, Islam, Mahmud, Ayar, Yavuz, Gorgulu, Numan, Karadag, Serhat, Gok, Mahmut, Akcali, Esra, Bora, Feyza, Aydin, Zeki, Altun, Eda, Ahbap, Elbis, Polat, Mehmet, Soypacaci, Zeki, Oguz, Ebru Gok, Koyuncu, Sumeyra, Colak, Hulya, Sahin, Idris, Dolarslan, Murside Esra, Helvaci, Ozant, Kurultak, Ilhan, Eren, Zehra, Dheir, Hamad, Ogutmen, Melike Betul, Taymez, Dilek Guven, Genek, Dilek Gibyeli, Ozkurt, Sultan, Bakir, Elif Ari, Yuksel, Enver, Sahutoglu, Tuncay, Oto, Ozgur Akin, Boz, Gulsah, Sengul, Erkan, Kara, Ekrem, Tuglular, Serhan, MÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Gibeyli Genek, Dilek, and RTEÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü

Subjects
Male, Turkey, retrospective study, proportional hazards model, Comorbidity, urologic and male genital diseases, Biochemistry, intensive care unit, Severity of Illness Index, DISEASE, law.invention, hazard ratio, Medical Conditions, Endocrinology, CLINICAL CHARACTERISTICS, middle aged, Hospital Mortality, education.field_of_study, adult, Hazard ratio, Acute kidney injury, clinical trial, cohort analysis, WUHAN, aged, risk factor, Nephrology, Creatinine, diabetes mellitus, Medicine, disease severity, Infection, Wuhan, medicine.medical_specialty, hypertension, Death Rates, Endocrine Disorders, Science, causal attribution, complication, Article, Population Metrics, turkey (bird), Severity of illness, CKD, Renal Diseases, Ckd, Humans, human, education, Retrospective Studies, Biology and Life Sciences, Covid 19, sex ratio, medicine.disease, major clinical study, mortality, DIALYSIS PATIENTS, Health Care, hospital discharge, multicenter study, TRANSPLANT, sex factor, Health Care Facilities, observational study, Biomarkers, Dialysis Patients, Viral Diseases, mortality rate, Transplant, law, Risk Factors, INFECTION, Chronic Kidney Disease, Medicine and Health Sciences, Disease, Multidisciplinary, Mortality rate, chronic kidney failure, Acute Kidney Injury, Intensive care unit, Hospitals, virology, Hospitalization, hospital patient, Intensive Care Units, Infectious Diseases, female, Anatomy, Research Article, Population, coronavirus disease 2019, Sex Factors, acute kidney failure, blood, Internal medicine, medicine, Mortality, outcome assessment, Proportional Hazards Models, Population Biology, L-Lactate Dehydrogenase, business.industry, lactate dehydrogenase blood level, isolation and purification, SARS-CoV-2, disease association, COVID-19, Kidneys, lactate dehydrogenase, Renal System, Metabolic Disorders, pathology, business, Kidney disease, in-hospital mortality
Abstract

BackgroundAcute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.MethodsIn this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients.ResultsThe median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0–1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04–2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06–2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08–3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05–2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25–3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44–3.51], p = 0.0001) were independent predictors of in-hospital mortality.ConclusionsAdvanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.

Published
2021

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