Acute kidney injury (AKI) develops early and frequently among patients hospitalized with COVID-19 and is associated with a poor prognosis, according to investigators. AKI also occurs in temporal association with respiratory failure.

The findings are from the first large-scale study of AKI in patients hospitalized with COVID-19. Conducted by investigators at the Feinstein Institutes for Medical Research in Manhasset, New York, the study included 5449 patients hospitalized with the disease from March 1 to April 5, 2020 at 13 Northwell Health academic and community hospitals in the New York metropolitan area. AKI developed in 1993 (36.6%) of these patients, Jamie S. Hirsch, MD, and colleagues reported in Kidney International. The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4%, and stage 3 in 31.1%. AKI mainly was observed in patients with respiratory failure, with AKI developing in 89.7% of patients on mechanical ventilation compared with 21.7% of patients not requiring ventilation.

In addition, 276 (96.8%) of 285 of patients requiring renal replacement therapy were on ventilators. Of patients who required ventilation and experienced AKI, onset of AKI occurred within 24 hours of intubation in 52.2% of them. 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, 694 died (35%), 519 (26%) were discharged and 780 (39%) remained hospitalized.


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“This [study] will guide us in planning for areas of surge in the next coming months or a re-surge in the fall 2020,” said co-investigator Steven Fishbane, MD, Chief of Nephrology of Northwell Health and Professor of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Great Neck, New York. “It will guide in terms of having enough supplies for dialysis, dialysis staff and inpatient nephrologists to tackle this large volume of cases.”

In a news release, corresponding author Kenar D. Jhaveri, MD, related, “Working amidst the COVID-19 epicenter was an experience we will never forget. Nephrologists and the dialysis staff were on the front lines of this battle trying to help every patient we could.”

Reference

Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020. https://doi.org/10.1016/j.kint.2020.05.006.