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Kidney Week

Abstract: PO0034

Rapid Deterioration or a Long Road to Recovery for COVID-19 Patients with AKI

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Ratnayake, Aruni, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Sarnowski, Alexander, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Annear, Nicholas M.P., St George's University Hospitals NHS Foundation Trust, London, United Kingdom
  • Chis Ster, Irina, St George's University of London, London, United Kingdom
  • Banerjee, Debasish, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
Background

Global reports on the rates, risk factors and outcomes of acute kidney injury (AKI) with COVID-19 exhibit high variability. We evaluated all patients admitted with AKI to our centre where COVID-19 status was determined by PCR, and assessed risk factors for poor outcomes including death.

Methods

Retrospective study of all patients admitted with AKI between 13/03/2020 and 13/05/2020. All variables including COVID-19 status, demographics, co-morbidities and laboratory parameters were collected from electronic patient records. We used competing risk-regression models to assess association with mortality by subdistribution hazards ratio (SHR).

Results

Of 576 patients admitted with AKI, 257 (43.6%) were positive for COVID-19. Demographics and clinical characteristics of our cohort included: mean age 66.7 years, 58% male, 40.5% Caucasian, 56.3% hypertension, 33.1% diabetes.

Overall 52.5% patients had AKI stage 1, 18.6% AKI stage 2, and 28.8% AKI stage 3. Patients with AKI stage 3 were 3.4 (95% CI 2.27-5.02) times more likely to be diagnosed with COVID-19 than those with AKI stage 1. Other factors associated with an increased likelihood of COVID-19 diagnosis adjusted for AKI stage were young age (p=0.004), non-Caucasian ethnicity (p=0.001), low lymphocyte count (p=0.002) and raised CRP, ferritin and D-dimer (p=0.001).

Case fatality percentage of this cohort was 32.5% (10%, 19% and 35% mortality in COVID-19 negative patients with AKI stages 1, 2 and 3 respectively, compared with 33%, 52% and 71% in the COVID-19 positive counterparts). Patients with COVID-19 were 3.6 (95% CI 2.2-4.3) times more likely to die than those negative for COVID-19 (p<0.001).

Furthermore, death in patients with COVID-19 and AKI stage 3 occurred rapidly, with 50% of patients dying within 10 days, 70% within 15 days and 95% within 21 days of admission. Those in the same group who survived had prolonged recovery, with 50% remaining inpatients in hospital for over 31 days.

Conclusion

In patients with AKI, those who were positive for COVID-19 was associated with severe AKI, younger age, non-Caucasian ethnicity, raised inflammatory markers, and suffered from high case fatality. Severity of AKI in conjunction with COVID-19 was associated with high and rapid death rates, or prolonged hospital admission with increased morbidity.