Severe acute kidney injury (AKI) in patients hospitalized with COVID-19 is associated with a high risk for death, according to a new meta-analysis.

The meta-analysis, which examined pooled data from 955 COVID-19 patients in 3 studies, found that found that COVID-19 patients who had severe AKI, compared with those who did not, had a significant 4-fold increased risk of death, Hatem Ali, MD, of University Hospitals of Birmingham, Birmingham, UK, Sohail Abdul Salim, MD, of the University of Mississippi Medical Center in Jackson, and colleagues reported in the Renal Failure.

“Based on the available limited published data, severe AKI in patients with COVID-19 is an ominous clinical predictor and is associated with high mortality,” the investigators concluded.

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They considered patients to have severe AKI if they required acute renal replacement therapy (RRT) or met the Kidney Disease Improving Global Outcome definition of AKI stage 3.

“The high mortality in COVID-19 patients and severe AKI, even with RRT, could be due to the kidney-lung crosstalk during COVID-19 infection and amplification of inflammation during AKI in a cohort with high incidence of acute respiratory distress syndrome,” the investigators concluded.

Dr Salim told Renal & Urology News that patients who survived most commonly ended up needing long-term dialysis.

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The meta-analysis included a study by Yichun Cheng, MD, and colleagues at Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. The study, published in Kidney International, included 701 patients with confirmed COVID-19, AKI stage 3 developed in 14 of them (2%), and this was significantly associated with a nearly 10-fold increased risk in-hospital death. Another study included in the meta-analysis was by Xiaobo Yang, MD, of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, and colleagues, and it included 52 patients with confirmed COVID-19. The study, published in Lancet Respiratory Medicine, found that 8 of 9 patients who required renal replacement therapy (RRT) died. The third study, by Fei Zhou, MD, and colleagues, included 191 patients with COVID-19. All 10 patients who required RRT died. Of the 33 COVID-19 patients who developed AKI, 32 died, according to a report in The Lancet.


Ali H, Daoud A, Mohamed MM, et al. Survival rate in acute kidney injury superimposed COVID-19 patients: A systemic review and meta-analysis [published online April 27, 2020]. Ren Fail. doi: 10.1080/0886022X.2020

Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97:829-838. doi: 10.1016/j.kint.2020.03.005

Yang X, Yu Y, Shu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered retrospective observational study [published online February 24, 2020]. Lancet Respir Med. doi: 10.1016/S2213-2600(20)30079-5

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229): 1054–1062. doi: 10.1016/S0140-6736(20)30566-3