Abstract: PO0705
Risk Factors for AKI in Patients Hospitalized with COVID-19
Session Information
- COVID-19: AKI and Outcomes
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Nadamuni, Mridula, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Liu, Yu-Lun, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Khan, Sadaf S., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Shastri, Shani, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Willett, Duwayne L., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Rajora, Nilum, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Chen, Catherine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Hedayati, Susan, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
Background
We evaluated risk factors and prevalence associated with AKI in our early experiences with patients hospitalized with COVID-19, 32% of whom required ICU level care, at the University of Texas Southwestern and Parkland Hospitals in Dallas, Texas from 3/13/20-5/07/20.
Methods
Patients admitted with COVID-19 confirmed by SARS-CoV2 PCR test were screened for AKI. Univariate and multivariate logistic regression using backward selection identified factors associated with AKI.
Results
COVID-19 was confirmed in 145 patients, of whom 62 (43%) had AKI. Patients with AKI were older, mean (SD) age 60 (17) vs. 54 (15) years without AKI, p=0.03, and were more likely to have hypertension, 74% vs. 47%, p=0.002, and diabetes mellitus, 61% vs. 31%, p<0.001. CKD was present in 42% of those with AKI vs. 7% of those without, p<0.001. Race, ethnicity, and ACEI/ARB use did not differ between groups. Patients with AKI had higher CRP, median (IQR) 102 (44-161) vs. 59 (21-116) mg/L, p=0.009, and LDH on presentation, 365 (265-493) vs. 317 (228-385) U/L, p=0.04. Ferritin, IL-6, and D-dimer was similar between groups. A higher percent with AKI received steroids, 42% vs. 16%, p<0.001. Tocilizumab was administered in 15% of AKI vs. 5% of non-AKI groups, p=0.08 while rates of hydroxychloroquine and remdesivir use did not differ. Renal replacement therapy was required in 8 patients with AKI, of whom 7 received CVVHDF and 1 HD. There were 8 (13%) deaths in those with AKI vs. 5 (6%) in those without. Factors associated with AKI are listed (Table).
Conclusion
During the first weeks of COVID-19 outbreak at our hospitals, 43% of patients had AKI. Underlying CKD, diabetes, steroid use and illness severity were independently associated with AKI. Follow-up is needed to determine the long-term impact on kidney function and recovery.
| Variable | Univariate OR (95% CI) | P | Multivariate OR (95% CI) | P |
| Age (year) | 1.02 (1.00, 1.05) | 0.03 | - | - |
| HTN | 3.24 (1.59, 6.62) | 0.001 | - | - |
| CKD | 9.27 (3.51, 24.50) | <0.001 | 5.94 (1.78, 19.78) | 0.004 |
| DM | 3.47 (1.74, 6.92) | <0.001 | 2.90 (1.15, 7.26) | 0.02 |
| CRP | 1.01 (1.00, 1.01) | 0.03 | - | - |
| D-Dimer | 1.23 (1.02, 1.48) | 0.03 | - | - |
| LDH | 1.00 (1.00, 1.01) | 0.03 | - | - |
| Steroids | 3.82 (1.76, 8.35) | 0.001 | 5.33 (1.88,15.10) | 0.002 |
| Tocilizumab | 3.35 (0.98,11.45) | 0.05 | - | - |
| ICU | 2.43 (1.19, 4.95) | 0.01 | 4.01 (1.60, 10.07) | 0.003 |