AKI in Hospitalized Patients with COVID-19

  1. Lili Chan
  2. Kumardeep Chaudhary
  3. Aparna Saha
  4. Kinsuk Chauhan
  5. Akhil Vaid
  6. Shan Zhao
  7. Ishan Paranjpe
  8. Sulaiman Somani
  9. Felix Richter
  10. Riccardo Miotto
  11. Anuradha Lala
  12. Arash Kia
  13. Prem Timsina
  14. Li Li
  15. Robert Freeman
  16. Rong Chen
  17. Jagat Narula
  18. Allan C. Just
  19. Carol Horowitz
  20. Zahi Fayad
  21. Carlos Cordon-Cardo
  22. Eric Schadt
  23. Matthew A. Levin
  24. David L. Reich
  25. Valentin Fuster
  26. Barbara Murphy
  27. John C. He
  28. Alexander W. Charney
  29. Erwin P. Böttinger
  30. Benjamin S. Glicksberg
  31. Steven G. Coca
  32. Girish N. Nadkarni
  33. on behalf of the Mount Sinai COVID Informatics Center (MSCIC)

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Abstract

Early reports have indicated that AKI and other kidney abnormalities are associated with coronavirus disease 2019 (COVID-19). Of 3993 hospitalized patients with COVID-19 in a New York City health system, AKI occurred in 1835 (46%) patients; among patients with AKI, 19% required dialysis, and half of them died in the hospital. Among patients who were discharged, 35% had not recovered to baseline kidney function at the time of discharge. AKI is common among patients with COVID-19 and is associated with higher mortality than in patients without AKI; among those who survive, only about a third are discharged with renal recovery. These findings may help centers with resource planning and preparing for the increased load resulting from survivors of COVID-19–associated AKI who do not experience recovery of kidney function.

Background

Early reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described.

Methods

This retrospective, observational study involved a review of data from electronic health records of patients aged ≥18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality.

Results

Of 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up.

Conclusions

AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.

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  1. Version published to 10.1681/asn.2020050615
  2. ScreenIT

    SciScore for 10.1101/2020.05.04.20090944: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Mount Sinai Institutional Review Board approved this research under a broad regulatory protocol allowing for analysis of patient-level data.
    RandomizationPatients from the Mount Sinai (MSH) were randomly split into a training and validation set for the model.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot 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:
    Our study should be interpreted in light of the following limitations. Over half of patients did not have a baseline creatinine values. However, we used MDRD imputation as suggested by KDIGO guidelines, and the incidence was nearly identical for those with known baseline serum creatinine vs. those that we imputed because of missing serum creatinine prior to admission.7 Recovery was assessed at time of discharge which may not reflect patients’ new baseline kidney function. As the COVID-19 pandemic is still evolving, few long term follow up lab test have been performed. We did not have sufficient data on inflammatory makers (e.g., interleukin 6, ferritin, and fibrinogen) in a large proportion of patients since they were not routinely checked early in the pandemic and a majority of patients did not have these values.22 Additionally, urinalysis was also missing in the majority of patients and we did not include in the analysis, although further studies could benefit from characterizing the urinalysis profile of COVID-19 associated AKI. Lastly, baseline medications of interest including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, and other non-steroidal anti-inflammatory drugs were not included. In conclusion, in a diverse cohort of patients with hospitalized with COVID-19 in NYC, we described a very high incidence of AKI, severe AKI requiring dialysis, and risk of death associated with AKI. We identified several predictors associated severe A...

    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.

    About SciScore

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  3. Version published to 10.1101/2020.05.04.20090944v1 on medRxiv