Acute kidney injury: Incidence, risk factors, and outcomes in severe COVID-19 patients

Background COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear. Methods We performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020 and June 2020, at the University Hospital, São Paulo, Brazil. Patients aged ≥ 18 years with COVID-19 confirmed on RT-PCR were included. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the incidence of AKI, several clinical variables, medicines used, and outcomes in two sub-groups: COVID-19 patients with AKI (Cov-AKI), and COVID-19 patients without AKI (non-AKI). Univariate and multivariate analyses were performed. Results First, an elevated incidence of AKI (71.2%) was identified, distributed across different stages of the KDIGO criteria. We further observed higher levels of creatinine, C-reactive protein (CRP), leukocytes, neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in the Cov-AKI group than in the non-AKI group, at hospital admission. On univariate analysis, Cov-AKI was associated with older age (>62 years), hypertension, CRP, MCV, leucocytes, neutrophils, NLR, combined hydroxychloroquine and azithromycin treatment, use of mechanical ventilation, and vasoactive drugs. Multivariate analysis showed that hypertension and the use of vasoactive drugs were independently associated with a risk of higher AKI in COVID-19 patients. Finally, we preferentially found an altered erythrocyte and leukocyte cellular profile in the Cov-AKI group compared to the non-AKI group, at hospital discharge. Conclusions In our study, the development of AKI in patients with severe COVID-19 was related to inflammatory blood markers and therapy with hydroxychloroquine/azithromycin, with vasopressor requirement and hypertension considered potential risk factors. Thus, attention to the protocol, hypertension, and some blood markers may help assist doctors with decision-making for the management of COVID-19 patients with AKI.

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COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

BMC Nephrology ◽

10.1186/s12882-021-02557-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Paul D. Jewell ◽

Kate Bramham ◽

James Galloway ◽

Frank Post ◽

Sam Norton ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Impairment ◽

Strong Predictor ◽

Kidney Injury ◽

Injury Incidence ◽

Tertiary Centre ◽

Incidence Risk ◽

Stage 1 ◽

Worse Prognosis

Abstract Background Acute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre. Methods We analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020. Results Of the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24–4,18; p < 0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27–2.53; p < 0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19–2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82–4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17–4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months. Conclusions This large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3–6 months.

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ACUTE KIDNEY INJURY INCIDENCE, RISK FACTORS, AND COSTS AMONG US PATIENTS UNDERGOING PERCUTANEOUS CORONARY PROCEDURES

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31900-x ◽

2019 ◽

Vol 73 (9) ◽

pp. 1293 ◽

Cited By ~ 1

Author(s):

Anand Prasad ◽

Ning Rosenthal ◽

Alex Kartashov ◽

Kim Knish ◽

Jill Dreyfus

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Injury Incidence ◽

Percutaneous Coronary ◽

Incidence Risk ◽

Coronary Procedures

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Colistimethate sodium and acute kidney injury: Incidence, risk factors, outcome and prognosis of renal function

Nefrología ◽

10.1016/j.nefro.2020.04.007 ◽

2020 ◽

Vol 40 (6) ◽

pp. 647-654

Author(s):

Saúl Pampa-Saico ◽

Vicente Pintado ◽

Alfonso Muriel ◽

Fernando Caravaca-Fontan ◽

Estefanía Yerovi-León ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Function ◽

Kidney Injury ◽

Injury Incidence ◽

Incidence Risk ◽

Colistimethate Sodium

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Incidence, Risk Factors and Mortality Outcome in Patients with Acute Kidney Injury in COVID-19: A Single-Center Observational Study

10.1101/2020.06.24.20138230 ◽

2020 ◽

Cited By ~ 1

Author(s):

Alfano Gaetano ◽

Ferrari Annachiara ◽

Fontana Francesco ◽

Mori Giacomo ◽

Magistroni Riccardo ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cox Regression ◽

Case Fatality ◽

Kidney Injury ◽

Serum Levels ◽

University Hospital ◽

Hospital Death ◽

Cox Regression Analysis ◽

Incidence Risk

AbstractBackgroundAcute kidney injury (AKI) is a recently recognized complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate the incidence, risk factors and case-fatality rate of AKI in patients with documented COVID-19.MethodsWe reviewed the health medical records of 307 consecutive patients hospitalized for symptoms of COVID-19 at the University Hospital of Modena, Italy.ResultsAKI was diagnosed in 69 out of 307 (22.4%) patients. The stages of AKI were stage 1 in 57.9%, stage 2 in 24.6% and stage 3 in 17.3%. Hemodialysis was performed in 7.2% of the subjects. AKI patients had a mean age of 74.7±9.9 years and higher serum levels of the main marker of inflammation and organ involvement (lung, liver, hearth and liver) than non-AKI patients. AKI events were more frequent in subjects with severe lung comprise. Two peaks of AKI events coincided with in-hospital admission and death of the patients. Kidney injury was associate with a higher rate of urinary abnormalities including proteinuria (0.448±0.85 vs 0.18±0.29; P=<0.0001) and hematuria (P=0.032) compared to non-AKI patients. At the end of follow-up, 65.2% of the patients did not recover their renal function after AKI. Risk factors for kidney injury were age, male sex, CKD and non-renal SOFA. Adjusted Cox regression analysis revealed that AKI was independently associated with in-hospital death (hazard ratio [HR]=3.74; CI 95%, 1.34-10.46) compared to non-AKI patients. Groups of patients with AKI stage 2-3 and failure to recover kidney function were associated with the highest risk of in-hospital mortality. Lastly, long-hospitalization was positively associated with a decrease of serum creatinine, likely due to muscle depletion occurred with prolonged bed rest.ConclusionsAKI was a dire consequence of patients with COVID-19. Identification of patients at high-risk for AKI and prevention of kidney injury by avoiding dehydration and nephrotoxic agents is imperative in this vulnerable cohort of patients.

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Colistimethate sodium and acute kidney injury: Incidence, risk factors, outcome and prognosis of renal function

Nefrología (English Edition) ◽

10.1016/j.nefroe.2020.11.010 ◽

2020 ◽

Vol 40 (6) ◽

pp. 647-654

Author(s):

Saúl Pampa-Saico ◽

Vicente Pintado ◽

Alfonso Muriel ◽

Fernando Caravaca-Fontan ◽

Estefanía Yerovi-León ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Function ◽

Kidney Injury ◽

Injury Incidence ◽

Incidence Risk ◽

Colistimethate Sodium

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Acute kidney injury after the arterial switch operation: incidence, risk factors, and outcomes

Cardiology in the Young ◽

10.1017/s1047951121003176 ◽

2021 ◽

pp. 1-6

Author(s):

Nikki J. Schoenmaker ◽

Jesse A. Weeda ◽

Roel L.F. van der Palen ◽

Mark G. Hazekamp ◽

Heleen E. Bunker-Wiersma

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Serum Creatinine ◽

Arterial Switch Operation ◽

Kidney Injury ◽

Single Centre ◽

Arterial Switch ◽

Switch Operation ◽

Incidence Risk ◽

Potential Risk Factors

Abstract Background: The aim of this retrospective cohort study was to determine the incidence, potential risk factors, characteristics, and outcomes of acute kidney injury in children following the arterial switch operation for transposition of the great arteries. Methods: Retrospective review of children who underwent ASO between 2000 and 2020 in our tertiary children’s hospital in the Netherlands. Pre-and post-ASO serum creatinine levels were collected. Severe AKI was defined as 100% serum creatinine rise or estimated creatinine clearance <35 ml/min/1.73 m2 according to pRIFLE criteria. Logistic regression was used to adjust for confounders. Results: A total of 242 children were included. Fifty-seven (24%) children developed severe AKI after ASO. Four patients with severe AKI were treated with renal replacement therapy. Children with severe AKI had a longer duration of mechanical ventilation 4.5 (1.0–29) versus 3 (1.0–12) days (p = 0.001), longer PICU stay 7 (2–76) versus 5 (1–70) days, (p = 0.001), higher rate of myocardial infarction 5% versus 0.5% (p = 0.001), sepsis 24% versus 9% (p = 0.002), post-operative pulmonary hypertension 19% versus 6% (p = 0.002), post-operative bleeding 9% versus 3% (p = 0.044), longer time to sternal closure 3 (1–19) versus 2 (1–6) days, (p = 0.009), and a higher mortality rate 9.0% versus 0.5% (p = 0.001) compared to children without severe AKI. Sepsis was a risk factor for developing severe AKI. Conclusions: In this single-centre cohort, 24% of our patients developed severe AKI after ASO, which is associated with increased morbidity, longer PICU stay, and higher mortality.

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Correction to: COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

BMC Nephrology ◽

10.1186/s12882-021-02617-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Paul D. Jewell ◽

Kate Bramham ◽

James Galloway ◽

Frank Post ◽

Sam Norton ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Injury Incidence ◽

Incidence Risk

An amendment to this paper has been published and can be accessed via the original article.

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Lesão Renal Aguda Após Implantação Percutânea de Válvula Aórtica: Incidência, Fatores de Risco e Impacto na Mortalidade

Acta Médica Portuguesa ◽

10.20344/amp.11308 ◽

2020 ◽

Vol 33 (10) ◽

pp. 664

Author(s):

Ana Martins ◽

Lurdes Castro ◽

Isabel Fragata

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Kidney Injury ◽

Injury Incidence ◽

Transcatheter Aortic Valve ◽

Incidence Risk ◽

Aortic Valve Implantation ◽

Valve Implantation

Introduction: Acute kidney injury is a frequent complication after transcatheter aortic valve implantation with great impact on morbidity and mortality. It is important to identify modifiable risk factors in order to develop preventive strategies. The aim of the study is to determine acute kidney injury incidence, risk factors and impact in patients that underwent transcatheter aortic valve implantation.Material and Methods: Retrospective study in 149 consecutive patients that underwent transcatheter aortic valve implantation at Santa Marta Hospital. The data was collected from the periprocedural records and stratified by the occurrence of acute kidney injury according to the AKIN classification.Results: A total of 149 patients, 43.0% male with median age 82.00 [77.50 – 85.00] years were included in the study. Incidence of acute kidney injury was 14.8% (n = 22). Female patients (OR 0.138, CI 95%; 0.022 – 0.854; p = 0.033) had a higher risk of that complication. Patients with acute kidney injury had longer hospitalizations (OR 1.043, CI 95%; 1.001 – 1.085; p = 0.043); acute kidney injury was associated with increased 30 day mortality (OR 13.889, 95% CI; 2.371 – 81.363; p = 0.004).Discussion: Acute kidney injury is associated with preprocedural variables and is a determinant of morbimortality. However, the retrospective character and the reduced sample size didn’t allow the determination of the precise weight of each factor.Conclusion: Acute kidney injury is a complication after transcatheter aortic valve implantation which played a significant role in morbimortality justifying its prevention.

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