Patients with COVID-19 who experience acute kidney injury (AKI) are more likely to die compared with those without AKI, investigators reported at Kidney Week 2020 Reimagined, a virtual meeting sponsored by the American Society of Nephrology.1

In a systematic review and meta-analysis of 26 studies including 5497 hospitalized patients with confirmed COVID-19, AKI occurred in 8.4%, with nearly half of these patients (3.6%) requiring renal replacement therapy, Panupong Hansrivijit, MD, of UPMC Pinnacle Harrisburg in Harrisburg, Pennsylvania, and colleagues reported. AKI was more likely to develop in critically ill patients than other hospitalized patients (19.9% vs 7.3%). Critically ill patients were twice as likely to die as other hospitalized patients (33% vs 16.1%). AKI was significantly associated with 13-fold increased odds of death compared with no AKI.

Preliminary data suggest patients infected with SARS-CoV-2, the novel coronavirus that causes COVID-19, have a lower incidence of kidney involvement compared with patients infected with Middle East respiratory syndrome coronavirus (MERS-CoV), according to the investigators.

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AKI significantly associated with increased mortality in an unadjusted model. Older age, diabetes, hypertension, and baseline serum creatinine levels all significantly associated with higher AKI incidence in adjusted analyses.

The investigators previously published their findings in the Journal of Investigative Medicine.2

Older age and diabetes are well-known risk factors for AKI. In addition, physicians should pay close attention to patients with elevated baseline serum creatinine levels because they have higher risk of developing AKI, Dr Hansrivijit told Renal & Urology News. Avoiding medications that can cause AKI should be encouraged, especially among patients with risk factors but normal creatinine, he said.

Dr Hansrivijit also discussed unpublished data showing that patients with hospital- vs community-acquired AKI and intrinsic vs prerenal AKI had higher mortality risks. Urine profile, including fractional excretion of sodium and fractional excretion of urea, were not helpful in differentiating AKI in COVID-19 patients, he noted.


Hansrivijit P, Boonpheng B, Thongprayoon C, Cheungpasitporn W, Ghahramani N. Incidence of AKI and its association with mortality in coronavirus disease 2019 (COVID-19) patients: a meta-analysis. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster PO0664. 

Panupong H, Chenchen Q, Boonphiphop B, et al. Incidence of acute kidney injury and its association with mortality in patients with COVID-19: a meta-analysis. J Invest Med. doi:10.1136/jim-2020-001407