HDCN Abstract:  ASN Annual Meeting 2020 -- Digital Meeting  

Ng JH, Hirsch JS, Fishbane S, et al.

AKI in Patients Hospitalized with COVID-19

ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:31A 2020

BACKGROUND

The rate of AKI associated with patients hospitalized with Covid-19, and associated outcomes are not well understood.

METHODS

We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 hospitals in metropolitan New York. Patients younger than 18 years of age, with ESKD or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. The primary outcome was the development of AKI. Secondary outcomes included need for RRT and hospital disposition, i.e., discharge or death. The RRT modalities offered to patients with AKI in our health system were intermittent HD or CRRT. All patients were followed up through April 12th, 2020. We additionally analyzed urine results including urine electrolytes and urinalysis with automated microscopy that were obtained within 24 hours before or 48 hours after the initial development of AKI.

RESULTS

Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation(Figure and Table). Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 1136 died (57%), 519 (26%) were discharged and 338 (17%) were still hospitalized.

CONCLUSION

AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis.


The probability of acute kidney injury diagnosis relative to time of mechanical ventilation.

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