Significant proportions of patients hospitalized with COVID-19 experience electrolyte disturbances or acute kidney injury (AKI) and require renal replacement therapy (RRT), according to new research findings.  

In a systematic review and meta-analysis of 22 observational cohort studies involving 17,391 hospitalized patients with COVID-19 from the United States and China, 5.2% had preexisting chronic kidney disease (CKD) and 2.3% had end-stage kidney disease. Over a 2- to 28-day hospital stay, electrolyte disturbances, notably hyperkalemia developed in 12.5% of patients, AKI in 11.0%, alkalosis in 6.9%, and acidosis in 5.0%. In addition, 6.8% required RRT, , Setor Kunutsor, MD, PhD, and Jari Laukkanen, MD, PhD, of the University of Bristol in Bristol, United Kingdom, reported in the Annals of Medicine. Patients with preexisting CKD, particularly in the United States, were more likely to develop AKI, the most commonly reported outcome. AKI occurred in similar proportions of patients younger and older than 60 years.

“Monitoring of markers of kidney function during hospitalization for COVID-19 could help in the identification of patients who at high risk for worse outcomes, to enable early and more aggressive intervention,” Dr Kunutsor and Dr Laukkanen wrote.

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The authors noted that ACE2 is expressed on mesangial cells, podocytes, parietal epithelium of Bowman’s capsule, and collecting ducts in the kidneys. The mechanisms for the renal manifestations of COVID-19 are still unclear, however, and may involve multiple factors, such as direct viral involvement, lung protective fluid management of acute renal distress syndrome, or cytokine storm.


Kunutsor SK, Laukkanen JA. Renal complications in COVID-19: a systematic review and meta-analysis [published online July 10, 2020]. Annals Med. doi: 10.1080/07853890.2020.1790643