Characteristics and outcomes of acute kidney injury in hospitalized

Abstract

Background Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI. Methods In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients. Results The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. Conclusions Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.

C1 [Arikan, Hakki; Tuglular, Serhan] Marmara Univ, Dept Internal Med, Div Nephrol, Sch Med, Istanbul, Turkey.

[Ozturk, Savas; Karadag, Serhat] Haseki Training & Res Hosp, Dept Nephrol, Istanbul, Turkey.

[Tokgoz, Bulent; Koyuncu, Sumeyra] Erciyes Univ Sch Med, Dept Internal Med, Div Nephrol, Kayseri, Turkey.

[Dursun, Belda] Pamukkale Univ, Dept Internal Med, Div Nephrol, Med Sch, Denizli, Turkey.

[Seyahi, Nurhan; Trabulus, Sinan] Istanbul Univ, Cerrahpasa Med Fac, Dept Nephrol, Istanbul, Turkey.

[Islam, Mahmud] Zonguldak Ataturk State Hosp, Div Nephrol, Zonguldak, Turkey.

[Ayar, Yavuz] Univ Hlth Sci, Bursa City Hosp, Fac Med, Div Nephrol, Bursa, Turkey.

[Gorgulu, Numan] Univ Hlth Sci, Istanbul Bagcilar Training & Res Hosp, Dept Nephrol, Istanbul, Turkey.

[Gok, Mahmut] Sultan 2 Abdulhamid Han Training & Res Hosp, Dept Nephrol, Istanbul, Turkey.

[Akcali, Esra] Mersin Univ, Dept Nephrol, Fac Med, Mersin, Turkey.

[Bora, Feyza] Akdeniz Univ Fac Med, Dept Internal Med, Div Nephrol, Antalya, Turkey.

[Aydin, Zeki] Univ Hlth Sci, Kocaeli Dar Farabi Training & Res Hosp, Dept Nephrol, Kocaeli, Turkey.

[Altun, Eda] Golcuk Necati Cel State Hosp, Div Nephrol, Kocaeli, Turkey.

[Ahbap, Elbis] Sisli Hamidiye Etfal Educ & Res Hosp, Dept Nephrol, Istanbul, Turkey.

[Polat, Mehmet] Nevsehir State Hosp, Div Nephrol, Nevsehir, Turkey.

[Soypacaci, Zeki] Univ Katip Celebi, Ataturk Training & Res Hosp, Dept Nephrol, Izmir, Turkey.

[Oguz, Ebru Gok] Univ Hlth Sci, Diskapi Yildirim Beyazit Educ & Res Hosp, Dept Nephrol, Ankara, Turkey.

[Colak, Hulya] Univ Hlth Sci, Div Nephrol, Tepecik Educ & Res Hosp, Izmir, Turkey.

[Sahin, Idris] Inonu Univ, Dept Internal Med, Div Nephrol, Fac Med, Malatya, Turkey.

[Dolarslan, Murside Esra] Univ Hlth Sci, Trabzon Kanuni Educ & Res Hosp, Div Nephrol, Trabzon, Turkey.

[Helvaci, Ozant] Yildirim Beyazit Univ, Yenimahalle Res & Training Hosp, Div Nephrol, Fac Med, Ankara, Turkey.

[Kurultak, Ilhan] Trakya Univ, Dept Nephrol, Fac Med, Edirne, Turkey.

[Eren, Zehra] Alanya Alaaddin Keykubat Univ, Dept Nephrol, Sch Med, Antalya, Turkey.

[Dheir, Hamad] Sakarya Univ Med, Dept Internal Med, Div Nephrol, Fac Educ & Res Hosp, Sakarya, Turkey.

[Ogutmen, Melike Betul] Univ Hlth Sci, Haydarpasa Numune Educ & Res Hosp, Div Nephrol, Istanbul, Turkey.

[Taymez, Dilek Guven] Kocaeli State Hosp, Nephrol & Dialysis Dept, Kocaeli, Turkey.

[Genek, Dilek Gibyeli] Mugla Sitki Kocman Univ, Fac Med, Dept Nephrol, Mugla, Turkey.

[Ozkurt, Sultan] Eskisehir Osmangazi Univ, Fac Med, Dept Nephrol, Eskisehir, Turkey.

[Bakir, Elif Ari] Bahcesehir Univ Hosp, Dept Nephrol, Istanbul, Turkey.

[Yuksel, Enver] Univ Hlth Sci, Gaziyasargil Training & Res Hosp, Dept Nephrol, Diyarbakir, Turkey.

[Sahutoglu, Tuncay] Sanliurfa Mehmet Akif Inan Training & Res Hosp, Nephrol Unit, Sanliurfa, Turkey.

[Oto, Ozgur Akin] Istanbul Univ, Istanbul Med Fac, Dept Internal Med, Div Nephrol, Istanbul, Turkey.

[Boz, Gulsah] Kayseri City Training & Res Hosp, Div Nephrol, Kayseri, Turkey.

[Sengul, Erkan] Univ Hlth Sci, Kocaeli Derince Educ & Res Hosp, Div Nephrol, Kocaeli, Turkey.

[Kara, Ekrem] Recep Tayyip Erdogan Univ, Fac Med, Dept Internal Med, Div Nephrol, Rize, Turkey.