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

  1. Alfano Gaetano
  2. Ferrari Annachiara
  3. Fontana Francesco
  4. Mori Giacomo
  5. Magistroni Riccardo
  6. Meschiari Marianna
  7. Franceschini Erica
  8. Menozzi Marianna
  9. Cuomo Gianluca
  10. Orlando Gabriella
  11. Santoro Antonella
  12. Di Gaetano Margherita
  13. Puzzolante Cinzia
  14. Carli Federica
  15. Bedini Andrea
  16. Milic Jovana
  17. Raggi Paolo
  18. Girardis Massimo
  19. Mussini Cristina
  20. Cappelli Gianni
  21. Guaraldi Giovanni
  22. for the Modena Covid-19 Working Group (MoCo19)
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Abstract

Background

Acute 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.

Methods

We reviewed the health medical records of 307 consecutive patients hospitalized for symptoms of COVID-19 at the University Hospital of Modena, Italy.

Results

AKI 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.

Conclusions

AKI 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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