Incidence and Risk Factors for Acute Kidney Injury and Its Effect on Mortality in Patients Hospitalized From COVID-19

Abhishek Nimkar; Ashutossh Naaraayan; Amrah Hasan; Sushil Pant; Momcilo Durdevic; Corina Nava Suarez; Henrik Elenius; Aram Hambardzumyan; Kameswari Lakshmi; Michael Mandel; Stephen Jesmajian

doi:10.1016/j.mayocpiqo.2020.07.003

Incidence and Risk Factors for Acute Kidney Injury and Its Effect on Mortality in Patients Hospitalized From COVID-19

Mayo Clin Proc Innov Qual Outcomes. 2020 Dec;4(6):687-695. doi: 10.1016/j.mayocpiqo.2020.07.003. Epub 2020 Jul 19.

Affiliation

¹ Department of Medicine, Montefiore New Rochelle Hospital, New Rochelle, NY.

Abstract

Objective: To determine the incidence of and risk factors for the development of acute kidney injury (AKI) and investigate the association between AKI and mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) infection.

Patients and methods: This retrospective case series includes the first 370 patients consecutively hospitalized with confirmed COVID-19 illness between March 10, 2020, and May 13, 2020, at a 242-bed teaching hospital. To determine independent associations between demographic factors, comorbid conditions, and AKI incidence, multivariable logistic regression models were used to estimate odds ratios adjusted for clinical covariates.

Results: Median age of patients was 71 (interquartile range, 59-82) years and 44.3% (145 of 327) were women. Patients with AKI were significantly older with a higher comorbid condition burden and mortality rate (58.1% [104 0f 179] vs 19.6% [29 of 148]; P<.001) when compared with those without AKI. Increasing age, chronic kidney disease, hyperlipidemia, and being of African American descent showed higher odds of AKI. Patients with AKI had significantly higher odds of mortality when compared with patients without AKI, and this effect was proportional to the stage of AKI. Increasing age and acute respiratory distress syndrome also revealed higher adjusted odds of mortality.

Conclusions: Acute kidney injury is a common complication among hospitalized patients with COVID-19 infection. We found significantly higher odds of AKI with increasing age and among patients with hyperlipidemia, those with chronic kidney disease, and among African Americans. We demonstrate an independent association between AKI and mortality with increasingly higher odds of mortality from progressively worsening renal failure in hospitalized patients with COVID-19 infection.

Keywords: ACE-2, angiotensin converting enzyme 2; AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; BMI, body mass index; CKD, chronic kidney disease; COVID-19, coronavirus disease 2019; OR, odds ratio; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.