Hypophosphatemia is an independent risk factor for AKI among hospitalized patients with COVID-19 infection

Renal Failure

卷:43

Yixin Zha¹  Jialin Liu²  Yufang Bi³  Xiaogang Xiang⁴  Jun Xue⁵  Yuhan Huang⁶  Qinjie Weng⁶  Xiang Li⁶  Li Lin⁶  Chenni Gao⁶  Shuwen Yu⁶  Xiaonong Chen⁶  Wenjie Wei⁶  Jingyuan Xie⁶  Nan Chen⁶  Haijin Yu⁶  Jian Liu⁶  Zijin Chen⁶  Xiaofan Hu⁶  Yan Ouyang⁶  Zhengying Fang⁶  Hafiz Muhammad Jafar Hussain⁶  Jun Tong⁶  Lin Lu⁷  Zhiyin Ye⁸  Chuanlei Li⁸  Jun Liu⁸  Tingting Jiang⁸  Jieshuang Jia⁸  Wei Chen⁹  Weiguo Hu¹⁰  Cijiang John He¹¹  Benjamin J. Lee¹²  Dan Liu¹³  Yuan Song¹⁴  Huiming Wang¹⁴  Xifeng Lv¹⁴  Xiaoman Xu¹⁵  Mingyu Liu¹⁶ 

[1] Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University;

[2] Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University, School of medicine;

[3] Department of Endocrinology and Metabolism disease, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine;

[4] Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine;

[5] Department of Nephrology, Huashan Hospital, Fudan University;

[6] Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine;

[7] Department of Nephrology, North Huashan Hospital, Fudan University;

[8] Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University;

[9] Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, Shanghai Jiao Tong University, School of Medicine;

[10] Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine;

[11] Division of Nephrology, Mount Sinai School of Medicine;

[12] Houston Kidney Consultants;

[13] Radiology Department of Renmin Hospital, Wuhan University;

[14] Renal Department of Renmin Hospital, Renmin Hospital of Wuhan University;

[15] Renal Department, Wuhan Ninth Hospital;

[16] Wuhan Ninth Hospital;

关键词: covid-19;    proximal tubule;    acute kidney injury;    risk factors;    hypophosphate;   

DOI  :  10.1080/0886022X.2021.1979039

来源: DOAJ

【 摘 要 】

Background This study sought to investigate incidence and risk factors for acute kidney injury (AKI) in hospitalized COVID-19. Methods In this retrospective study, we enrolled 823 COVID-19 patients with at least two evaluations of renal function during hospitalization from four hospitals in Wuhan, China between February 2020 and April 2020. Clinical and laboratory parameters at the time of admission and follow-up data were recorded. Systemic renal tubular dysfunction was evaluated via 24-h urine collections in a subgroup of 55 patients. Results In total, 823 patients were enrolled (50.5% male) with a mean age of 60.9 ± 14.9 years. AKI occurred in 38 (40.9%) ICU cases but only 6 (0.8%) non-ICU cases. Using forward stepwise Cox regression analysis, we found eight independent risk factors for AKI including decreased platelet level, lower albumin level, lower phosphorus level, higher level of lactate dehydrogenase (LDH), procalcitonin, C-reactive protein (CRP), urea, and prothrombin time (PT) on admission. For every 0.1 mmol/L decreases in serum phosphorus level, patients had a 1.34-fold (95% CI 1.14–1.58) increased risk of AKI. Patients with hypophosphatemia were likely to be older and with lower lymphocyte count, lower serum albumin level, lower uric acid, higher LDH, and higher CRP. Furthermore, serum phosphorus level was positively correlated with phosphate tubular maximum per volume of filtrate (TmP/GFR) (Pearson r = 0.66, p < .001) in subgroup analysis, indicating renal phosphate loss via proximal renal tubular dysfunction. Conclusion The AKI incidence was very low in non-ICU patients as compared to ICU patients. Hypophosphatemia is an independent risk factor for AKI in patients hospitalized for COVID-19 infection.

【 授权许可】

Unknown