Background Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19. Methods We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy. Results AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 +/- 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 +/- 0.85 vs 0.18 +/- 0.29 mg/mg; P = < 0.0001) and microscopic hematuria (P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio [HR] = 4.82; CI 95%, 1.36-17.08) compared to non-AKI patients. Conclusion AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients.

Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19 / Alfano, Gaetano; Ferrari, Annachiara; Fontana, Francesco; Mori, Giacomo; Magistroni, Riccardo; Meschiari, Marianna; Franceschini, Erica; Menozzi, Marianna; Cuomo, Gianluca; Orlando, Gabriella; Santoro, Antonella; Digaetano, Margherita; Puzzolante, Cinzia; Carli, Federica; Bedini, Andrea; Milic, Jovana; Coloretti, Irene; Raggi, Paolo; Mussini, Cristina; Girardis, Massimo; Cappelli, Gianni; Guaraldi, Giovanni. - In: CLINICAL AND EXPERIMENTAL NEPHROLOGY. - ISSN 1342-1751. - 25:11(2021), pp. 1203-1214. [10.1007/s10157-021-02092-x]

Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19

Alfano, Gaetano;Fontana, Francesco;Mori, Giacomo;Magistroni, Riccardo;Meschiari, Marianna;Franceschini, Erica;Cuomo, Gianluca;Orlando, Gabriella;Santoro, Antonella;Puzzolante, Cinzia;Carli, Federica;Bedini, Andrea;Coloretti, Irene;Mussini, Cristina;Girardis, Massimo;Cappelli, Gianni;Guaraldi, Giovanni
2021

Abstract

Background Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19. Methods We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy. Results AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 +/- 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 +/- 0.85 vs 0.18 +/- 0.29 mg/mg; P = < 0.0001) and microscopic hematuria (P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio [HR] = 4.82; CI 95%, 1.36-17.08) compared to non-AKI patients. Conclusion AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients.
2021
25
11
1203
1214
Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19 / Alfano, Gaetano; Ferrari, Annachiara; Fontana, Francesco; Mori, Giacomo; Magistroni, Riccardo; Meschiari, Marianna; Franceschini, Erica; Menozzi, Marianna; Cuomo, Gianluca; Orlando, Gabriella; Santoro, Antonella; Digaetano, Margherita; Puzzolante, Cinzia; Carli, Federica; Bedini, Andrea; Milic, Jovana; Coloretti, Irene; Raggi, Paolo; Mussini, Cristina; Girardis, Massimo; Cappelli, Gianni; Guaraldi, Giovanni. - In: CLINICAL AND EXPERIMENTAL NEPHROLOGY. - ISSN 1342-1751. - 25:11(2021), pp. 1203-1214. [10.1007/s10157-021-02092-x]
Alfano, Gaetano; Ferrari, Annachiara; Fontana, Francesco; Mori, Giacomo; Magistroni, Riccardo; Meschiari, Marianna; Franceschini, Erica; Menozzi, Marianna; Cuomo, Gianluca; Orlando, Gabriella; Santoro, Antonella; Digaetano, Margherita; Puzzolante, Cinzia; Carli, Federica; Bedini, Andrea; Milic, Jovana; Coloretti, Irene; Raggi, Paolo; Mussini, Cristina; Girardis, Massimo; Cappelli, Gianni; Guaraldi, Giovanni
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