tetano
Editor, Senior Moderator
Clin Exp Nephrol
. 2021 Jul 1.
doi: 10.1007/s10157-021-02092-x. Online ahead of print.
Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19
Gaetano Alfano[SUP] 1 2 [/SUP], Annachiara Ferrari[SUP] 3 [/SUP], Francesco Fontana[SUP] 4 [/SUP], Giacomo Mori[SUP] 4 [/SUP], Riccardo Magistroni[SUP] 4 3 [/SUP], Marianna Meschiari[SUP] 5 [/SUP], Erica Franceschini[SUP] 5 [/SUP], Marianna Menozzi[SUP] 5 [/SUP], Gianluca Cuomo[SUP] 5 [/SUP], Gabriella Orlando[SUP] 5 [/SUP], Antonella Santoro[SUP] 5 [/SUP], Margherita Digaetano[SUP] 5 [/SUP], Cinzia Puzzolante[SUP] 5 [/SUP], Federica Carli[SUP] 5 [/SUP], Andrea Bedini[SUP] 5 [/SUP], Jovana Milic[SUP] 6 3 [/SUP], Irene Coloretti[SUP] 7 [/SUP], Paolo Raggi[SUP] 8 [/SUP], Cristina Mussini[SUP] 3 5 [/SUP], Massimo Girardis[SUP] 7 [/SUP], Gianni Cappelli[SUP] 4 3 [/SUP], Giovanni Guaraldi[SUP] 3 5 [/SUP], Modena Covid-19 Working Group (MoCo19)
Affiliations
Abstract
Background: Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19.
Methods: We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy.
Results: AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 ± 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 ± 0.85 vs 0.18 ± 0.29 mg/mg; P = < 0.0001) and microscopic hematuria (P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio
= 4.82; CI 95%, 1.36-17.08) compared to non-AKI patients.
Conclusion: AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients.
Keywords: AKI; COVID-19; Dialysis; Mortality; Risk factors; Urine.
. 2021 Jul 1.
doi: 10.1007/s10157-021-02092-x. Online ahead of print.
Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19
Gaetano Alfano[SUP] 1 2 [/SUP], Annachiara Ferrari[SUP] 3 [/SUP], Francesco Fontana[SUP] 4 [/SUP], Giacomo Mori[SUP] 4 [/SUP], Riccardo Magistroni[SUP] 4 3 [/SUP], Marianna Meschiari[SUP] 5 [/SUP], Erica Franceschini[SUP] 5 [/SUP], Marianna Menozzi[SUP] 5 [/SUP], Gianluca Cuomo[SUP] 5 [/SUP], Gabriella Orlando[SUP] 5 [/SUP], Antonella Santoro[SUP] 5 [/SUP], Margherita Digaetano[SUP] 5 [/SUP], Cinzia Puzzolante[SUP] 5 [/SUP], Federica Carli[SUP] 5 [/SUP], Andrea Bedini[SUP] 5 [/SUP], Jovana Milic[SUP] 6 3 [/SUP], Irene Coloretti[SUP] 7 [/SUP], Paolo Raggi[SUP] 8 [/SUP], Cristina Mussini[SUP] 3 5 [/SUP], Massimo Girardis[SUP] 7 [/SUP], Gianni Cappelli[SUP] 4 3 [/SUP], Giovanni Guaraldi[SUP] 3 5 [/SUP], Modena Covid-19 Working Group (MoCo19)
Affiliations
- PMID: 34196877
- DOI: 10.1007/s10157-021-02092-x
Abstract
Background: Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19.
Methods: We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy.
Results: AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 ± 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 ± 0.85 vs 0.18 ± 0.29 mg/mg; P = < 0.0001) and microscopic hematuria (P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio
= 4.82; CI 95%, 1.36-17.08) compared to non-AKI patients.
Conclusion: AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients.
Keywords: AKI; COVID-19; Dialysis; Mortality; Risk factors; Urine.