Kidney disease is associated with in-hospital death of patients with COVID-19
- PMID: 32247631
- PMCID: PMC7110296
- DOI: 10.1016/j.kint.2020.03.005
Kidney disease is associated with in-hospital death of patients with COVID-19
Abstract
In December 2019, a coronavirus 2019 (COVID-19) disease outbreak occurred in Wuhan, Hubei Province, China, and rapidly spread to other areas worldwide. Although diffuse alveolar damage and acute respiratory failure were the main features, the involvement of other organs needs to be explored. Since information on kidney disease in patients with COVID-19 is limited, we determined the prevalence of acute kidney injury (AKI) in patients with COVID-19. Further, we evaluated the association between markers of abnormal kidney function and death in patients with COVID-19. This was a prospective cohort study of 701 patients with COVID-19 admitted in a tertiary teaching hospital that also encompassed three affiliates following this major outbreak in Wuhan in 2020 of whom 113 (16.1%) died in hospital. Median age of the patients was 63 years (interquartile range, 50-71), including 367 men and 334 women. On admission, 43.9% of patients had proteinuria and 26.7% had hematuria. The prevalence of elevated serum creatinine, elevated blood urea nitrogen and estimated glomerular filtration under 60 ml/min/1.73m2 were 14.4, 13.1 and 13.1%, respectively. During the study period, AKI occurred in 5.1% patients. Kaplan-Meier analysis demonstrated that patients with kidney disease had a significantly higher risk for in-hospital death. Cox proportional hazard regression confirmed that elevated baseline serum creatinine (hazard ratio: 2.10, 95% confidence interval: 1.36-3.26), elevated baseline blood urea nitrogen (3.97, 2.57-6.14), AKI stage 1 (1.90, 0.76-4.76), stage 2 (3.51, 1.49-8.26), stage 3 (4.38, 2.31-8.31), proteinuria 1+ (1.80, 0.81-4.00), 2+∼3+ (4.84, 2.00-11.70), and hematuria 1+ (2.99, 1.39-6.42), 2+∼3+ (5.56,2.58- 12.01) were independent risk factors for in-hospital death after adjusting for age, sex, disease severity, comorbidity and leukocyte count. Thus, our findings show the prevalence of kidney disease on admission and the development of AKI during hospitalization in patients with COVID-19 is high and is associated with in-hospital mortality. Hence, clinicians should increase their awareness of kidney disease in patients with severe COVID-19.
Keywords: COVID-19; acute kidney injury; in-hospital death; kidney disease; pneumonia.
Copyright © 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
Figures
Similar articles
-
Acute Kidney Injury in Patients with the Coronavirus Disease 2019: A Multicenter Study.Kidney Blood Press Res. 2020;45(4):612-622. doi: 10.1159/000509517. Epub 2020 Jul 24. Kidney Blood Press Res. 2020. PMID: 32712607 Clinical Trial.
-
Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia.J Am Soc Nephrol. 2020 Jun;31(6):1157-1165. doi: 10.1681/ASN.2020030276. Epub 2020 Apr 28. J Am Soc Nephrol. 2020. PMID: 32345702
-
[Clinical characteristics and risk factors of acute kidney injury in coronavirus disease 2019].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Apr;32(4):407-411. doi: 10.3760/cma.j.cn121430-20200302-00198. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020. PMID: 32527342 Chinese.
-
Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit.JAMA Netw Open. 2020 Jun 1;3(6):e2012270. doi: 10.1001/jamanetworkopen.2020.12270. JAMA Netw Open. 2020. PMID: 32543702 Free PMC article. Review.
-
Management of acute kidney injury in patients with COVID-19.Lancet Respir Med. 2020 Jul;8(7):738-742. doi: 10.1016/S2213-2600(20)30229-0. Epub 2020 May 14. Lancet Respir Med. 2020. PMID: 32416769 Free PMC article. Review.
Cited by 164 articles
-
The epidemiological burden of and overall distribution of chronic comorbidities in coronavirus disease-2019 among 202,005 infected patients: evidence from a systematic review and meta-analysis.Infection. 2020 Aug 19:1-21. doi: 10.1007/s15010-020-01502-8. Online ahead of print. Infection. 2020. PMID: 32813220 Free PMC article. Review.
-
Outcomes of patients with end-stage kidney disease hospitalized with COVID-19.Kidney Int. 2020 Aug 15:S0085-2538(20)30945-5. doi: 10.1016/j.kint.2020.07.030. Online ahead of print. Kidney Int. 2020. PMID: 32810523 Free PMC article.
-
Subarachnoid hemorrhage guidance in the era of the COVID-19 pandemic - An opinion to mitigate exposure and conserve personal protective equipment.J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105010. doi: 10.1016/j.jstrokecerebrovasdis.2020.105010. Epub 2020 Jun 5. J Stroke Cerebrovasc Dis. 2020. PMID: 32807425 Free PMC article. Review.
-
The potential effectiveness of acetazolamide in the prevention of acute kidney injury in COVID-19: A hypothesis.Eur J Pharmacol. 2020 Aug 15;888:173487. doi: 10.1016/j.ejphar.2020.173487. Online ahead of print. Eur J Pharmacol. 2020. PMID: 32805256 Free PMC article.
-
Acute Kidney Injury in COVID-19 Pneumonia: A Single-Center Experience in Bahrain.Cureus. 2020 Aug 12;12(8):e9693. doi: 10.7759/cureus.9693. Cureus. 2020. PMID: 32802627 Free PMC article.
References
Publication types
MeSH terms
Supplementary concepts
LinkOut - more resources
-
Full Text Sources
-
Medical