Am J Kidney Dis. 2020 Sep 19:S0272-6386(20)30998-7. doi: 10.1053/j.ajkd.2020.09.002. Online ahead of print.
RATIONALE & OBJECTIVE: Outcomes of patients hospitalized with 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 (age ≥18) hospitalized with COVID-19 at 13 hospitals in metropolitan New York, between March 1, 2020 - April 27, 2020, followed until hospital discharge.
EXPOSURE: Acute kidney injury.
OUTCOME(S): Primary outcome - in-hospital death. Secondary outcome - requiring dialysis at discharge, recovery of kidney function.
ANALYTICAL APPROACH: Univariable and multivariable time-to-event analysis and logistic regression.
RESULTS: Among 9657 patients admitted with COVID-19, the AKI incidence rate was 38.4/1000 patient-days. The incidence rates of in-hospital death among patients without AKI, with AKI not requiring kidney replacement therapy (AKI non-KRT) and with AKI receiving KRT (AKI-KRT) were 10.8, 31.1 and 37.5/1000 patient-days, respectively. The risks of in-hospital death for patients with AKI-non KRT and AKI-KRT were greater than among those without AKI (HR 5.6 [95% CI 5.0-6.3] and HR 11.3 [95% CI 9.6 - 13.1], respectively). After adjusting for demographics, comorbidities, and illness severity, the risk of death remained higher among those with AKI non-KRT (adjusted HR 3.4 [95% CI 3.0-3.9]) and AKI-KRT (adjusted HR 6.4 [95% CI 5.5-7.6]) compared to those without AKI. Among patients with AKI non-KRT who survived, 74.1% achieved kidney recovery by the time of discharge. Among those with AKI-KRT who survived, 30.6% remained on dialysis at discharge, and pre-hospitalization 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 peak of COVID-19 pandemic.
CONCLUSIONS: AKI in hospitalized patients with COVID-19 was associated with significant risk for death.