ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2021 and some content may be unavailable. To unlock all content for 2021, please visit the archives.

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.