Outcomes Among Patients Hospitalized With COVID-19 and Acute Kidney Injury.
Am J Kidney Dis
; 77(2): 204-215.e1, 2021 02.
Article
in English
| MEDLINE | ID: covidwho-780043
ABSTRACT
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. STUDYDESIGN:
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:
Primaryoutcome:
in-hospital death. SECONDARYOUTCOMES:
requiring dialysis at discharge, recovery of kidney function. ANALYTICALAPPROACH:
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.Keywords
AKI-on-CKD; COVID-19 outcomes; Coronavirus disease 2019 (COVID-19); acute kidney injury (AKI); acute renal failure (ARF); death; dialysis; hospitalization; in-hospital mortality; kidney replacement therapy (KRT); recovery; renal prognosis; renal recovery; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Renal Dialysis
/
Hospital Mortality
/
Acute Kidney Injury
/
COVID-19
/
Hospitalization
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
Limits:
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
Am J Kidney Dis
Year:
2021
Document Type:
Article
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