COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

BMC Nephrology

Rohit Saha¹  Sam Hutchings¹  Richard Fisher¹  James Teo²  Sam Norton³  James Galloway⁴  Frank Post⁵  Ali Mudhaffer⁶  Eirini Lioudaki⁶  Satish Jayawardene⁶  Henry Kibble⁶  Amelia Holloway⁶  Paul D. Jewell⁶  Priscilla Smith⁶  Kieran Palmer⁶  Benjamin Zuckerman⁶  Ciara Murphy⁶  Jennifer Joslin⁶  Sarah Mackie⁶  Mosammat Akter⁶  Domniki Iatropoulou⁶  Phil Hopkins⁷  Claire C. Sharpe⁸  Kate Bramham⁸ 

[1] Department of Critical Care, King’s College Hospital NHS Foundation Trust, London, UK;Department of Neurosciences, King’s College Hospital NHS Foundation Trust, London, UK;Faculty of Life Sciences and Medicine, King’s College London, London, UK;Faculty of Life Sciences and Medicine, King’s College London, London, UK;Centre for Rheumatic Disease, King’s College London, London, UK;Faculty of Life Sciences and Medicine, King’s College London, London, UK;Department of Sexual Health and HIV, King’s College Hospital NHS Foundation Trust, London, UK;Renal Unit, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, UK;Renal Unit, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, UK;Department of Critical Care, King’s College Hospital NHS Foundation Trust, London, UK;Renal Unit, King’s College Hospital NHS Foundation Trust, Denmark Hill, SE5 9RS, London, UK;Faculty of Life Sciences and Medicine, King’s College London, London, UK;

关键词: COVID-19;    AKI;    Mortality;    Renal replacement therapy;   

DOI  :  10.1186/s12882-021-02557-x

来源: Springer

【 摘 要 】

BackgroundAcute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre.MethodsWe analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020.ResultsOf the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24–4,18; p <  0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27–2.53; p <  0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19–2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82–4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17–4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months.ConclusionsThis large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3–6 months.

【 授权许可】

CC BY