Similar Rates of AKI during the First Two Waves of COVID-19 in Northern Italy: a single-center study

  1. Gaetano Alfano
  2. Silvia Giovanella
  3. Francesco Fontana
  4. Jovana Milic
  5. Giulia Ligabue
  6. Francesco Giaroni
  7. Camilla Ferri
  8. Martina Montali
  9. Andrea Melluso
  10. Morisi Niccolò
  11. Giacomo Mori
  12. Riccardo Magistroni
  13. Erica Franceschini
  14. Andrea Bedini
  15. Giacomo Cuomo
  16. Margherita DiGaetano
  17. Marianna Meschiari
  18. Cristina Mussini
  19. Gianni Cappelli
  20. Giovanni Guaraldi

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Abstract

Introduction

Two waves of COVID-19 cases have overwhelmed most European countries during 2020. It is unclear if the incidence of acute kidney injury (AKI) has changed during the COVID-19 outbreaks. This study aims to evaluate the differences in incidence, risk factors and outcome of AKI in patients with SARS-CoV-2 infection during the first and second wave of COVID-19.

Method

We reviewed the health medical records of 792 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy, from February 25 to December 14, 2020.

Results

AKI was diagnosed in 122 (15.4%) patients. Incidence of AKI remained steady rate during wave-1 (15.9%) and wave-2 (14.7%) (P=0.89). AKI patients were older (P=<0.001) and had a more severe respiratory impairment (PO2/FO2) (P=≤0.001) than their non-AKI counterparts. AKI led to a longer hospital stay (P=0.001), complicated with a higher rate of ICU admission. COVID-19-related AKI was associate with 59.7% of deaths during wave-1 and 70.6% during wave-2. At the end of the period of observation, 24% (wave-1) and 46.7% (wave-2) of survivors were discharged with a not fully recovered kidney function. Risk factors for AKI in patients with COVID-19 were diuretics (HR=5.3; 95%CI, 1.2-23.3; P=0.025) and cardiovascular disease (HR, 2.23; 95%CI, 1.05-5.1; P=0.036).

Conclusion

The incidence of AKI (about 15%) remained unchanged during 2020, regardless of the trend of COVID-19. AKI occurred in patients with severe COVID-19 symptoms and was associated with a higher incidence of deaths than non-AKI patients. The risk factors of COVID-19-related AKI were diuretic therapy and cardiovascular disease.

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  1. ScreenIT

    SciScore for 10.1101/2021.06.13.21258862: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study was approved by the regional ethical committee of Emilia Romagna (n. 0013376/20)
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The potential underestimation of AKI events is the main limitation of this study. The lack of baseline creatinine before admission and daily urine output is unintended bias largely reported in other studies.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.06.13.21258862v2 on medRxiv
  3. Version published to 10.1101/2021.06.13.21258862v1 on medRxiv