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Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury
Jia H Ng1, Jamie S Hirsch2, Azzour Hazzan1
1Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.
Insights
Patients hospitalized with coronavirus disease 2019 (COVID-19) who developed acute kidney injury (AKI) faced a significantly higher risk of in-hospital death. Kidney outcomes varied, with many survivors of severe AKI still requiring dialysis at discharge.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Outcomes for patients with coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) are not well understood.
- Understanding these outcomes is crucial for managing hospitalized patients during pandemics.
Purpose of the Study:
- To investigate the survival and kidney outcomes of patients hospitalized with COVID-19 and AKI.
- To determine the association between AKI and in-hospital mortality in COVID-19 patients.
Main Methods:
- Retrospective cohort study of 9,657 adult patients hospitalized with COVID-19.
- Analysis included univariable and multivariable time-to-event and logistic regression models.
- AKI incidence and outcomes (in-hospital death, dialysis, kidney function recovery) were assessed.
Main Results:
- AKI incidence was 38.4 per 1,000 patient-days.
- AKI significantly increased the risk of in-hospital death (adjusted HR 3.4-6.4).
- Among survivors, 74.1% with AKI stages 1-3 recovered kidney function, while 30.6% with AKI requiring dialysis remained on dialysis at discharge.
Conclusions:
- Acute kidney injury is a significant independent risk factor for mortality in hospitalized COVID-19 patients.
- Kidney function recovery varies significantly based on AKI severity, with chronic kidney disease predicting persistent dialysis needs.
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.
Study Design:
Retrospective cohort study.
Setting & Participants:
Patients (aged≥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.
Exposure:
AKI.
Outcomes:
Primary outcome: in-hospital death.
Secondary Outcomes:
requiring dialysis at discharge, recovery of kidney function.
Analytical Approach:
Univariable and multivariable time-to-event analysis and logistic regression.
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]).
Limitations:
Observational retrospective study, limited to the NY metropolitan area during the peak of the COVID-19 pandemic.
Conclusions:
AKI in hospitalized patients with COVID-19 was associated with significant risk for death.
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