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Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury.

Authors :
Ng JH
Hirsch JS
Hazzan A
Wanchoo R
Shah HH
Malieckal DA
Ross DW
Sharma P
Sakhiya V
Fishbane S
Jhaveri KD
Source :
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2021 Feb; Vol. 77 (2), pp. 204-215.e1. Date of Electronic Publication: 2020 Sep 19.
Publication Year :
2021

Abstract

Rationale & Objective: Outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) are not well understood. The goal of this study was to investigate the survival and kidney outcomes of these patients.<br />Study Design: Retrospective cohort study.<br />Setting & Participants: Patients (agedā‰„18 years) hospitalized with COVID-19 at 13 hospitals in metropolitan New York between March 1, 2020, and April 27, 2020, followed up until hospital discharge.<br />Exposure: AKI.<br />Outcomes: Primary outcome: in-hospital death.<br />Secondary Outcomes: requiring dialysis at discharge, recovery of kidney function.<br />Analytical Approach: Univariable and multivariable time-to-event analysis and logistic regression.<br />Results: Among 9,657 patients admitted with COVID-19, the AKI incidence rate was 38.4/1,000 patient-days. Incidence rates of in-hospital death among patients without AKI, with AKI not requiring dialysis (AKI stages 1-3), and with AKI receiving dialysis (AKI 3D) were 10.8, 31.1, and 37.5/1,000 patient-days, respectively. Taking those without AKI as the reference group, we observed greater risks for in-hospital death for patients with AKI 1-3 and AKI 3D (HRs of 5.6 [95% CI, 5.0-6.3] and 11.3 [95% CI, 9.6-13.1], respectively). After adjusting for demographics, comorbid conditions, and illness severity, the risk for death remained higher among those with AKI 1-3 (adjusted HR, 3.4 [95% CI, 3.0-3.9]) and AKI 3D (adjusted HR, 6.4 [95% CI, 5.5-7.6]) compared with those without AKI. Among patients with AKI 1-3 who survived, 74.1% achieved kidney recovery by the time of discharge. Among those with AKI 3D who survived, 30.6% remained on dialysis at discharge, and prehospitalization chronic kidney disease was the only independent risk factor associated with needing dialysis at discharge (adjusted OR, 9.3 [95% CI, 2.3-37.8]).<br />Limitations: Observational retrospective study, limited to the NY metropolitan area during the peak of the COVID-19 pandemic.<br />Conclusions: AKI in hospitalized patients with COVID-19 was associated with significant risk for death.<br /> (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1523-6838
Volume :
77
Issue :
2
Database :
MEDLINE
Journal :
American journal of kidney diseases : the official journal of the National Kidney Foundation
Publication Type :
Academic Journal
Accession number :
32961245
Full Text :
https://doi.org/10.1053/j.ajkd.2020.09.002