In the Journals

AKI common in patients with COVID-19, most frequent among those with respiratory failure

A study of patients admitted to New York hospitals with COVID-19 found acute kidney injury was common. Findings also suggested AKI developed in early stages of the disease and in conjunction with respiratory failure.

“The New York-Metropolitan area began to see a rapid increase in COVID-19 cases in February, 2020,” Jamie S. Hirsch, MD, of the Feinstein Institutes for Medical Research and Northwell Health, and colleagues wrote. “Our health system, with 23 hospitals in counties in and around NY City, rapidly experienced a surge in COVID-19 hospitalizations with over 9,000 at the time of this writing. As we cared for patients with COVID-19 disease, we noticed an alarming number of patients who developed acute kidney injury (AKI), at rates higher than had been reported from China.”

This observation could be due to differences in the way AKI was defined, as well as due to the populations studied, according to the researchers.

Arguing that limited comprehensive data exist on AKI and COVID-19 – including the timing of its development, its relationship to respiratory failure, analyses of subsequent dialysis requirements, post-AKI outcomes and risk factors – the researchers considered 5,449 patients with COVID-19 who were admitted to a Northwell Health system hospital between March and April 2020. Patients who were kidney transplant recipients or who had end-stage kidney disease were excluded.

Observing that AKI developed in 36.6% of admitted patients, the researchers determined it most commonly developed in stage one of the disease (for 46.5% of patients; 22.4%, stage two; 31.1%, stage 3).

Of all patients who developed AKI, 14.3% required renal replacement therapy [RRT].

The researchers wrote that AKI most frequently developed in patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients.

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Reference: Kidney International

Further findings indicated 96.8% of patients requiring RRT were on ventilators and, of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation.

Regarding post-AKI outcomes, the researchers determined 35% experienced mortality, with 26% being discharged and 39% still hospitalized.

The researchers noted risk factors for AKI included older age and the presence of diabetes mellitus, cardiovascular disease or hypertension. Black race, the need for ventilation and vasopressor medications were also identified as risk factors.

“Working amidst the COVID-19 epicenter was an experience we will never forget,” study co-author Kenar D. Jhaveri, MD, said in a related press release. “Nephrologists and the dialysis staff were on the frontlines of this battle trying to help every patient we could," he said. "We hope to learn more about the COVID-19-related AKI in the coming weeks, and that by sharing what we have learned from our patients, other doctors and their patients can benefit.” – by Melissa J. Webb

Disclosures: Jhaveri reports being a consultant for Astex Pharmaceuticals. All other authors report no relevant financial disclosures.

A study of patients admitted to New York hospitals with COVID-19 found acute kidney injury was common. Findings also suggested AKI developed in early stages of the disease and in conjunction with respiratory failure.

“The New York-Metropolitan area began to see a rapid increase in COVID-19 cases in February, 2020,” Jamie S. Hirsch, MD, of the Feinstein Institutes for Medical Research and Northwell Health, and colleagues wrote. “Our health system, with 23 hospitals in counties in and around NY City, rapidly experienced a surge in COVID-19 hospitalizations with over 9,000 at the time of this writing. As we cared for patients with COVID-19 disease, we noticed an alarming number of patients who developed acute kidney injury (AKI), at rates higher than had been reported from China.”

This observation could be due to differences in the way AKI was defined, as well as due to the populations studied, according to the researchers.

Arguing that limited comprehensive data exist on AKI and COVID-19 – including the timing of its development, its relationship to respiratory failure, analyses of subsequent dialysis requirements, post-AKI outcomes and risk factors – the researchers considered 5,449 patients with COVID-19 who were admitted to a Northwell Health system hospital between March and April 2020. Patients who were kidney transplant recipients or who had end-stage kidney disease were excluded.

Observing that AKI developed in 36.6% of admitted patients, the researchers determined it most commonly developed in stage one of the disease (for 46.5% of patients; 22.4%, stage two; 31.1%, stage 3).

Of all patients who developed AKI, 14.3% required renal replacement therapy [RRT].

The researchers wrote that AKI most frequently developed in patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients.

#
Reference: Kidney International

Further findings indicated 96.8% of patients requiring RRT were on ventilators and, of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation.

Regarding post-AKI outcomes, the researchers determined 35% experienced mortality, with 26% being discharged and 39% still hospitalized.

The researchers noted risk factors for AKI included older age and the presence of diabetes mellitus, cardiovascular disease or hypertension. Black race, the need for ventilation and vasopressor medications were also identified as risk factors.

“Working amidst the COVID-19 epicenter was an experience we will never forget,” study co-author Kenar D. Jhaveri, MD, said in a related press release. “Nephrologists and the dialysis staff were on the frontlines of this battle trying to help every patient we could," he said. "We hope to learn more about the COVID-19-related AKI in the coming weeks, and that by sharing what we have learned from our patients, other doctors and their patients can benefit.” – by Melissa J. Webb

Disclosures: Jhaveri reports being a consultant for Astex Pharmaceuticals. All other authors report no relevant financial disclosures.

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