Retrospective Analysis of Acute Kidney Injury in Hospitalizations with Covid-19
DOI:
https://doi.org/10.61882/ijkd.20.01.8878Keywords:
Acute kidney injury, COVID-19, Mortality, HemodialysisAbstract
Introduction. Coronavirus Disease 2019 (COVID-19) affected the entire world. While the effects on the lungs are more pronounced, the kidneys are also susceptible, and there is a potential risk of acute kidney injury (AKI) among COVID-19 patients. This study aimed to evaluate the incidence, clinical characteristics, and outcomes of AKI in patients hospitalized with COVID-19.
Methods. This study analyzed the incidence, characteristics, and outcomes of AKI in hospitalized patients with COVID-19. Medical records of 755 COVID-19 patients with AKI and 4647 patients without kidney injury admitted between March 2020 and July 2022 were analyzed at Karabuk Training and Research Hospital. We recorded patients’ demographic information, length of stay, laboratory results, and the necessity for renal replacement therapy. AKI staging was based on initial and peak values of renal parameters such as serum.
Results. The results indicated a high incidence of AKI in COVID-19patients, particularly in those requiring intensive care units (ICU), where mortality rates were significantly high. The findings revealed that patients with AKI, especially those requiring hemodialysis (n = 110, 49.32%), had lower rates of recovery and discharge (n = 633, 83.84%), and significantly higher mortality rates compared to those without AKI (P = .032). The mortality rate in patients requiring hemodialysis was 33.64%, underscoring the severity of AKI and the high mortality risk associated with cases necessitating hemodialysis.
Conclusion. The development of AKI in COVID-19 patients is associated with a significant increase in mortality risk, indicating the need for further detailed investigations to better understand this condition.
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1.Mayerhoefer T, Perschinka F, Joannidis M. Acute kidney injury and COVID-19: lung-kidney crosstalk during severe inflammation. Medizinische Klinik, Intensivmedizin und Notfallmedizin. 2022;117.5: 342-348 doi: 10.1007/s00063- 022-00919-3.
2.Ng JH, Hirsch JS, Hazzan A, et al. Outcomes among patients hospitalized with COVID-19 and acute kidneyinjury. American Journal of Kidney Diseases. 2021;77(2), 204-215. doi: 10.1053/j.ajkd.2020.09.002.
3.Yildirim C, Ozger HS, Yasar E, et al. Early predictors of acute kidney injury in COVID-19 patients. Nephrology. 2021;26(6), 513-521. doi: 10.1111/nep.13856.
4.Zahid U, Ramachandran P, Spitalewitz S, et al. Acute kidney injury in COVID-19 patients: an inner city hospital experience and policy implications. American journal of nephrology. 2020; 51(10), 786-796. doi: 10.1159/000511160.
5.Nugent J, Aklilu A, Yamamoto Y, et al. Assessment of acute kidney injury and longitudinal kidney function after hospital discharge among patients with and without COVID-19. JAMA network open. 2021;4(3), e211095-e211095. doi: 10.1001/ jamanetworkopen.2021.1095.
6.Ng JH, Bijol V, Sparks MA, Sise ME, Izzedine H, Jhaveri KD. Pathophysiology and pathology of acute kidney injury in patients with COVID-19. Advances in Chronic Kidney Disease. 2020;27(5), 365-376. doi: 10.1053/j. ackd.2020.09.003.
7.Moledina DG, Simonov M, Yamamoto Y, et al. The association of COVID-19 with acute kidney injury independent of severity of illness: a multicenter cohortstudy. American Journal of Kidney Diseases. 2021;77(4), 490-499. doi: 10.1053/j.ajkd.2020.12.007.
8.Kellum JA, van Till JO, Mulligan G. Targeting acute kidney injury in COVID-19. Nephrology Dialysis Transplantation. 2020;35(10), 1652-1662. doi: 10.1093/ndt/gfaa231.
9.Ghosn M, Attallah N, Badr M, et al. Severe acute kidney injury in critically ill patients with COVID-19 admitted
to ICU: incidence, risk factors, and outcomes. Journal of clinical medicine. 2021;10(6), 1217. doi: 10.3390/ jcm10061217.
10.Thomas ME, Blaine C, Dawnay A. Definition of acute kidney injury and its use inpractice, Kidney Int. 2015;87(1):62-73. doi: 10.1038/ki.2014.328.
11. Pelayo J, Lo KB, Bhargav R, et al. Clinical characteristics and outcomes of community-and hospital-acquired acute
kidney injury with COVID-19 in a US inner city hospital system. Cardiorenal medicine. 2020;10(4), 223-231. doi:
10.1159/000509182.
12. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-838. doi:10.1016/j. kint.2020.03.005.
13. Yang X, Tian S, Guo H. Acute kidney injury and renal replacement therapy in COVID-19 patients: A systematic review and meta-analysis. Int Immunopharmacol. 2021;90:107159. doi:10.1016/j.intimp.2020.107159.
14. Procaccini FL, Alcázar Arroyo R, Albalate Ramón M, et al. Acute kidney injury in 3182 patients admitted with COVID-19: a single-center, retrospective, case-control study. Clin Kidney J. 2021;14(6):1557-1569. doi: 10.1093/ ckj/sfab021.
15. Wang L, Li X, Chen H, et al. Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China. Am J Nephrol. 2020;51(5):343-348. doi:10.1159/000507471.
16. Rubin S, Orieux A, Prevel R, et al. Characterization of acute kidney injury in critically ill patients with severe
coronavirus disease 2019. Clin Kidney J. 2020;13(3):354- 361. doi:10.1093/ckj/sfaa099.
17. Lim JH, Park SH, Jeon Y, et al. Fatal Outcomes of COVID-19 in Patients with Severe Acute Kidney Injury. J Clin Med. 2020;9(6):1718. doi:10.3390/jcm9061718.
18. Li Q, Zhang T, Li F, et al. Acute Kidney Injury Can Predict In-Hospital Mortality in Elderly Patients with COVID-19
in the ICU: A Single-Center Study. Clin Interv Aging. 2020;15:2095-2107. doi:10.2147/CIA.S273720.
19. Husain-Syed F, Wilhelm J, Kassoumeh S, et al. Acute kidney injury and urinary biomarkers in hospitalized patients with coronavirus disease-2019. Nephrol Dial Transplant. 2020;35(7):1271-1274. doi:10.1093/ndt/gfaa162.
20. Taher A, Alalwan AA, Naser N, Alsegai O, Alaradi A. Acute Kidney Injury in COVID-19 Pneumonia: A Single- Center Experience in Bahrain. Cureus. 2020;12(8):e9693. doi:10.7759/cureus.9693.
21.Roushani J, Thomas D, Oliver MJ, et al. Acute kidneyinjury requiring renal replacement therapy in people with COVID-19 disease in Ontario, Canada: a prospective analysis of risk factors and outcomes. Clin Kidney J.2021;15(3):507-516. doi:10.1093/ckj/sfab237.
22.Charytan DM, Parnia S, Khatri M, et al. Decreasing Incidence of Acute Kidney Injury in Patients with COVID-19 Critical Illness in New York City. Kidney Int Rep. 2021;6(4):916-927. doi:10.1016/j.ekir.2021.01.036.
23.Basalely A, Gurusinghe S, Schneider J, et al. Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19. Kidney Int. 2021;100(1):138-145. doi:10.1016/j.kint.2021.02.026
24.Flythe JE, Assimon MM, Tugman MJ, et al. Characteristics and Outcomes of Individuals With Pre-existing Kidney Disease and COVID-19 Admitted to Intensive Care Units in the United States. Am J Kidney Dis. 2021;77(2):190- 203.e1. doi:10.1053/j.ajkd.2020.09.003.
25.Akilesh S, Nast CC, Yamashita M, et al. Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria. Am J Kidney Dis. 2021;77(1):82-93.e1. doi:10.1053/j.ajkd.2020.10.001.
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Data Availability Statement
Background: Coronavirus Disease 2019 (COVID-19), a pandemic that emerged in 2019 and has affected the entire world, arises from an infection with the SARS-CoV-2 virus. While the effects on the lungs are more pronounced, the kidneys are also at risk, and there is a potential for acute kidney injury (AKI) among COVID-19 patients.
Aims: This article aims to retrospectively analyze the incidence, characteristics, and outcomes of acute kidney injury (AKI) in individuals diagnosed with and hospitalized for COVID-19.
Methods: This study retrospectively examines the incidence, characteristics, and outcomes of acute kidney injury (AKI) in patients hospitalized with a diagnosis of COVID-19. Medical records of patients aged 18 and over admitted due to COVID-19 between March 2020 and July 2022 were analyzed. A total of 755 patients with AKI and 4647 patients without kidney injury were included in the study. The diagnosis and staging of AKI were based on the Kidney Disease Outcomes Quality Initiative (KDIGO) criteria. The study recorded patients' demographic information, length of stay, laboratory results, and the necessity for renal replacement therapy. AKI staging was based on initial and peak values of renal parameters such as serum creatinine and urea.
Results: The analysis results indicate a high rate of AKI development in COVID-19 patients, particularly in those requiring care in intensive care units (ICU), where mortality rates significantly increased. Findings reveal that patients with AKI, especially those requiring hemodialysis, had lower rates of recovery and discharge, and significantly higher mortality rates compared to those without AKI. The mortality rate in patients requiring hemodialysis was determined to be 33.64%, underscoring the severity of AKI and the high mortality risk associated with cases necessitating hemodialysis. The results of the study demonstrate that AKI significantly affects survival and renal outcomes in COVID-19 patients. AKI is a critical risk factor for in-hospital mortality, with an increased risk particularly evident in patients requiring intensive care and dialysis.
Conclusion: the development of AKI in COVID-19 patients is associated with a significant increase in mortality risk, indicating the need for further detailed investigations to better understand this condition.
