BMC Nephrology (Nov 2021)

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

  • Paul D. Jewell,
  • Kate Bramham,
  • James Galloway,
  • Frank Post,
  • Sam Norton,
  • James Teo,
  • Richard Fisher,
  • Rohit Saha,
  • Sam Hutchings,
  • Phil Hopkins,
  • Priscilla Smith,
  • Jennifer Joslin,
  • Satish Jayawardene,
  • Sarah Mackie,
  • Ali Mudhaffer,
  • Amelia Holloway,
  • Henry Kibble,
  • Mosammat Akter,
  • Benjamin Zuckerman,
  • Kieran Palmer,
  • Ciara Murphy,
  • Domniki Iatropoulou,
  • Claire C. Sharpe,
  • Eirini Lioudaki

DOI
https://doi.org/10.1186/s12882-021-02557-x
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 12

Abstract

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Abstract Background Acute 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. Methods We 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. Results Of 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. Conclusions This 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.

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