Acute kidney injury in 3182 patients admitted with COVID-19: a single center retrospective case-control study

Abstract Background Acute kidney injury (AKI) may develop in COVID-19 patients and may be associated with a worse outcome. The aim of this study is to describe AKI incidence during the first 45 days of the SARS-CoV2 pandemic in Spain, its reversibility and the association with mortality. Methods Observational retrospective case-control study based on patients hospitalized between March 1 and April 15, 2020 with SARS-CoV2 infection and AKI. Confirmed AKI cases were compared with stable kidney function patients for baseline characteristics, analytical data, treatment and renal outcome. Patients with end-stage kidney disease were excluded. Results AKI incidence was 17.22% among 3182 admitted COVID-19 patients and acute kidney disease (AKD) incidence was 6.82%. The most frequent causes of AKI were prerenal (68.8%) and sepsis (21.9%). Odds ratio for AKI was increased in patients with pre-existent hypertension (OR 2.58, 95% CI 1.71-3.89) and chronic kidney disease (OR 2.14, 95% CI 1.33-3.42) and in those with respiratory distress (OR 2.37, 95% CI 1.52-3.70). Low arterial pressure at admission increased the risk for stage 3 AKI (OR 1.65, 95% CI 1.09-2.50). Baseline kidney function was not recovered in 45.73% of overall AKI cases and in 52.75% of AKI patients with prior chronic kidney disease. Mortality was 38.5% compared to 13.4% of the overall sample population. AKI increased mortality risk at any time of hospitalization (HR 1.45, 95% CI 1.09-1.93). Conclusions AKI is frequent in COVID-19 patients and is associated to mortality, independently from acute respiratory distress syndrome. AKD was also frequent and merits adequate follow-up.

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MP217DIABETES MELLITUS DOES NOT INCREASE THE INCIDENCE OF ACUTE KIDNEY INJURY AFTER CARDIAC SURGERY IN PATIENTS WITH CHRONIC KIDNEY DISEASE; A NESTED CASE-CONTROL STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw187.23 ◽

2016 ◽

Vol 31 (suppl_1) ◽

pp. i412-i412

Author(s):

Loutradis Charalampos ◽

Maria Moschopoulou ◽

Foteini Ampatzidou ◽

Afroditi Mpoutou ◽

Charilaos-Panagiotis Koutsogiannidis ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Disease ◽

Case Control Study ◽

Kidney Injury ◽

Case Control ◽

Nested Case Control ◽

Control Study

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Abstract MP072: Association of Urinary Kidney Injury Biomarkers with Kidney Function Decline: A Case-Control Study from the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽

10.1161/circ.125.suppl_10.amp072 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Carmen A Peralta ◽

Ronit Katz ◽

Joseph V Bonventre ◽

Venkata Sabbisetti ◽

David Siscovick ◽

...

Keyword(s):

Kidney Disease ◽

Kidney Function ◽

Case Control Study ◽

Kidney Injury ◽

Case Control ◽

Urinary Biomarkers ◽

Tubular Injury ◽

Future Risk ◽

Kidney Function Decline ◽

Control Study

Background: The urinary biomarkers of tubular injury ((urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1)) can indicate acute kidney injury before reductions in estimated glomerular filtration rate (eGFR) are clinically detectable. Whether elevations of these markers are associated with future risk of kidney disease has not been investigated. Methods: We studied the association of urinary NGAL and KIM-1 with kidney function decline in a 1:1 ratio case-control study among 686 MESA participants. NGAL and KIM-1 were measured at baseline (standardized for urinary creatinine) and expressed both as continuous and in deciles. eGFR was estimated by cystatin C. Cases were defined as persons with eGFR>60 ml/min/1.73m 2 who subsequently developed incident CKD (defined as eGFR<60 plus eGFR decline > 1ml/min/year) and/or had rapid kidney function decline (RKFD, ≥3ml/min/1.73m 2 /year) by the MESA year 5 visit. Of the 343 cases, 145 had incident CKD, 141 had RKFD and 57 had both. Controls were matched for age, gender, race, diabetes, and baseline eGFR. We adjusted for age, hypertension and presence of albuminuria (ACR ≥30 mg/g). Results: Higher levels of KIM-1 were significantly associated with kidney function decline, and these associations were strongest for the top decile compared to lowest decile. Presence of albuminuria only minimally attenuated the findings. NGAL levels were not associated with kidney function decline. (Table) Model OR (95%CI) for Incident CKD and/or Rapid Kidney Function Decline KIM-1 (pg/ml) * KIM-1-Cr Ratio * (pg/mg) KIM-1 ≥ 927 pg/ml (Top Decile) NGAL (ng/ml) * NGAL-Cr Ratio * (ng/mg) NGAL ≥ 36 ng/ml (Top Decile) Age Adjusted 1.15 (1.02, 1.29) 1.17 (1.02, 1.34) 2.09 (1.21, 3.62) 1.04 (0.99, 1.10) 1.03 (0.98, 1.09) 1.63 (0.96, 2.78) Age + HTN Adjusted 1.15 (1.03, 1.29) 1.16 (1.01, 1.33) 2.13 (1.22, 3.70) 1.04 (0.99, 1.10) 1.03 (0.98, 1.09) 1.58 (0.93, 2.71) + ACR ≥ 30mg/g 1.15 (1.02, 1.29) 1.13 (0.98, 1.30) 2.02 (1.15, 3.56) 1.04 (0.99, 1.10) 1.03 (0.97, 1.08) 1.55 (0.89, 2.70) * Per doubling. Top decile is compared to lowest decile Conclusions: KIM-1, a marker of tubular injury, is associated with future risk of kidney disease independent of albuminuria. Our findings suggest that urinary biomarkers of tubular injury are a promising tool for identifying persons at risk for CKD.

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