Association of AKI-D with Urinary Findings and Baseline eGFR in Hospitalized COVID-19 Patients. Issue 8 (26th August 2021)

• Record Type: Journal Article
• Authors: Patel, Dipal M.; Phadke, Manali; Dai, Feng; Simonov, Michael; Dahl, Neera K.; Kodali, Ravi
• Is Part Of: Kidney360. Volume 2:Issue 8(2021)
• Page Start: 1215
• Page End: 1224
• Publication Date: 2021-08-26
• Subjects: acute kidney injury and ICU nephrology -- acute kidney failure -- acute kidney injury -- COVID-19 -- dialysis -- hematuria -- proteinuria -- risk factors; 616.61
• DOI: 10.34067/KID.0001612021
• Languages: English
• ISSNs: 2641-7650

Abstract

Visual Abstract: Abstract: Key Points: We evaluated risk factors for AKI requiring dialysis (AKI-D) in a cohort of 3186 patients hospitalized with coronavirus disease 2019. Patients who were Latino, men, and those with lower eGFR or obesity experienced more AKI-D. Patients with AKI-D had increased odds of mortality. After adjustment for covariates including baseline kidney function, proteinuria and hematuria were associated with increased odds of AKI-D. Background: AKI is common in patients hospitalized with coronavirus disease 2019 (COVID-19). Risk factors for AKI requiring dialysis (AKI-D) are not fully understood. We aimed to identify risk factors associated with AKI-D and AKI not requiring dialysis (AKI-ND). Methods: We reviewed electronic health records of 3186 patients aged ≥18 years old who were hospitalized with COVID-19 across six hospitals. Patient characteristics, urinalysis findings, and inflammatory markers were analyzed for association with in-hospital AKI status (AKI-D, AKI-ND, or no AKI), and we subsequently evaluated mortality. Results: After adjustment for multiple covariates, higher baseline eGFR was associated with 30% lower odds of AKI-D and 11% lower odds of AKI-ND (for AKI-D, OR, 0.70; 95% CI, 0.64 to 0.77; for AKI-ND, OR, 0.89; 95% CI, 0.85 to 0.92). Patients with obesity and those who were Latino had increased odds of AKI-D, whereas patients with congestive heart failure or diabetes with complications had increased odds of AKI-ND. Females had lower odds of in-hospital AKI (for AKI-D, OR, 0.28; 95% CI, 0.17 to 0.46; for AKI-ND, OR, 0.83; 95% CI, 0.70 to 0.99). After adjustment for covariates and baseline eGFR, 1–4+ protein on initial urinalysis was associated with a nine-fold increase in odds of AKI-D (OR, 9.00; 95% CI, 2.16 to 37.38) and more than two-fold higher odds of AKI-ND (OR, 2.28; 95% CI, 1.66 to 3.13). Findings of 1–3+ blood and trace glucose on initial urinalysis were also associated with increased odds of both AKI-D and AKI-ND. AKI-D and AKI-ND were associated with in-hospital death (for AKI-D, OR, 2.64; 95% CI, 1.13 to 6.17; for AKI-ND, OR, 2.44; 95% CI, 1.77 to 3.35). Conclusions: Active urine sediments, even after adjustment for baseline kidney function, and reduced baseline eGFR are significantly associated with increased odds of AKI-D and AKI-ND. In-hospital AKI was associated with in-hospital death. These findings may help prognosticate patients hospitalized with COVID-19.