TY - JOUR
T1 - Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury
AU - Northwell Nephrology COVID-19 Research Consortium
AU - Ng, Jia H.
AU - Hirsch, Jamie S.
AU - Hazzan, Azzour
AU - Wanchoo, Rimda
AU - Shah, Hitesh H.
AU - Malieckal, Deepa A.
AU - Ross, Daniel W.
AU - Sharma, Purva
AU - Sakhiya, Vipulbhai
AU - Fishbane, Steven
AU - Jhaveri, Kenar D.
AU - Abate, Mersema
AU - Andrade, Hugo Paz
AU - Barnett, Richard L.
AU - Bellucci, Alessandro
AU - Bhaskaran, Madhu C.
AU - Corona, Antonio G.
AU - Flores Chang, Bessy Suyin
AU - Finger, Mark
AU - Gitman, Michael
AU - Halinski, Candice
AU - Hasan, Shamir
AU - Hazzan, Azzour D.
AU - Hong, Susana
AU - Khanin, Yuriy
AU - Kuan, Aireen
AU - Madireddy, Varun
AU - Malieckal, Deepa
AU - Muzib, Abdulrahman
AU - Nair, Gayatri
AU - Nair, Vinay V.
AU - Ng, Jia Hwei
AU - Parikh, Rushang
AU - Sachdeva, Mala
AU - Schwarz, Richard
AU - Singhal, Pravin C.
AU - Uppal, Nupur N.
N1 - Publisher Copyright:
© 2020 National Kidney Foundation, Inc.
PY - 2021/2
Y1 - 2021/2
N2 - Rationale & Objective: Outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) are not well understood. The goal of this study was to investigate the survival and kidney outcomes of these patients. Study Design: Retrospective cohort study. Setting & Participants: Patients (aged ≥18 years) hospitalized with COVID-19 at 13 hospitals in metropolitan New York between March 1, 2020, and April 27, 2020, followed up until hospital discharge. Exposure: AKI. Outcomes: Primary outcome: in-hospital death. Secondary outcomes: requiring dialysis at discharge, recovery of kidney function. Analytical Approach: Univariable and multivariable time-to-event analysis and logistic regression. Results: Among 9,657 patients admitted with COVID-19, the AKI incidence rate was 38.4/1,000 patient-days. Incidence rates of in-hospital death among patients without AKI, with AKI not requiring dialysis (AKI stages 1-3), and with AKI receiving dialysis (AKI 3D) were 10.8, 31.1, and 37.5/1,000 patient-days, respectively. Taking those without AKI as the reference group, we observed greater risks for in-hospital death for patients with AKI 1-3 and AKI 3D (HRs of 5.6 [95% CI, 5.0-6.3] and 11.3 [95% CI, 9.6-13.1], respectively). After adjusting for demographics, comorbid conditions, and illness severity, the risk for death remained higher among those with AKI 1-3 (adjusted HR, 3.4 [95% CI, 3.0-3.9]) and AKI 3D (adjusted HR, 6.4 [95% CI, 5.5-7.6]) compared with those without AKI. Among patients with AKI 1-3 who survived, 74.1% achieved kidney recovery by the time of discharge. Among those with AKI 3D who survived, 30.6% remained on dialysis at discharge, and prehospitalization chronic kidney disease was the only independent risk factor associated with needing dialysis at discharge (adjusted OR, 9.3 [95% CI, 2.3-37.8]). Limitations: Observational retrospective study, limited to the NY metropolitan area during the peak of the COVID-19 pandemic. Conclusions: AKI in hospitalized patients with COVID-19 was associated with significant risk for death.
AB - Rationale & Objective: Outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) are not well understood. The goal of this study was to investigate the survival and kidney outcomes of these patients. Study Design: Retrospective cohort study. Setting & Participants: Patients (aged ≥18 years) hospitalized with COVID-19 at 13 hospitals in metropolitan New York between March 1, 2020, and April 27, 2020, followed up until hospital discharge. Exposure: AKI. Outcomes: Primary outcome: in-hospital death. Secondary outcomes: requiring dialysis at discharge, recovery of kidney function. Analytical Approach: Univariable and multivariable time-to-event analysis and logistic regression. Results: Among 9,657 patients admitted with COVID-19, the AKI incidence rate was 38.4/1,000 patient-days. Incidence rates of in-hospital death among patients without AKI, with AKI not requiring dialysis (AKI stages 1-3), and with AKI receiving dialysis (AKI 3D) were 10.8, 31.1, and 37.5/1,000 patient-days, respectively. Taking those without AKI as the reference group, we observed greater risks for in-hospital death for patients with AKI 1-3 and AKI 3D (HRs of 5.6 [95% CI, 5.0-6.3] and 11.3 [95% CI, 9.6-13.1], respectively). After adjusting for demographics, comorbid conditions, and illness severity, the risk for death remained higher among those with AKI 1-3 (adjusted HR, 3.4 [95% CI, 3.0-3.9]) and AKI 3D (adjusted HR, 6.4 [95% CI, 5.5-7.6]) compared with those without AKI. Among patients with AKI 1-3 who survived, 74.1% achieved kidney recovery by the time of discharge. Among those with AKI 3D who survived, 30.6% remained on dialysis at discharge, and prehospitalization chronic kidney disease was the only independent risk factor associated with needing dialysis at discharge (adjusted OR, 9.3 [95% CI, 2.3-37.8]). Limitations: Observational retrospective study, limited to the NY metropolitan area during the peak of the COVID-19 pandemic. Conclusions: AKI in hospitalized patients with COVID-19 was associated with significant risk for death.
KW - AKI-on-CKD
KW - COVID-19 outcomes
KW - Coronavirus disease 2019 (COVID-19)
KW - acute kidney injury (AKI)
KW - acute renal failure (ARF)
KW - death
KW - dialysis
KW - hospitalization
KW - in-hospital mortality
KW - kidney replacement therapy (KRT)
KW - recovery
KW - renal prognosis
KW - renal recovery
KW - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
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U2 - 10.1053/j.ajkd.2020.09.002
DO - 10.1053/j.ajkd.2020.09.002
M3 - Article
C2 - 32961245
AN - SCOPUS:85094174275
SN - 0272-6386
VL - 77
SP - 204-215.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -