Incidence of AKI in Patients Hospitalized with COVID-19

Kidney Week 2020

An estimated 8% to 18% of hospitalized patients develop acute kidney injury (AKI). Hospitalized patients who develop AKI are at increased risk for mortality; however, it is unknown whether there is an association between AKI and increased risk for mortality in patient hospitalized with coronavirus disease 2019 (COVID-19). Panupong Hansrivijit, MD, and colleagues conducted a study designed to examine the incidence of AKI and its association with mortality in COVID-19 patients.

The study utilized a systematic literature review and meta-analysis. Results were reported during a virtual poster session at ASN Kidney Week 2020 in a poster titled Incidence of AKI and Its Association with Mortality in Coronavirus Disease 2019 (COVID-19) Patients: A Meta-Analysis.

The search included Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible publications (without language restriction) that reported the clinical characteristics of patients with confirmed COVID-19. Eligible studies reported the incidence of AKI and mortality. Due to the emerging nature of the COVID-19 pandemic, there were a large number of studies published in a short time period. To avoid studies with duplicated patient populations, valid Institutional Review Board number or approval by the National Health Commission of the study’s country was screened.

From 26 eligible studies, representing 5497 patients, the pooled incidence of AKI in patients with COVID-19 was 8.4% (95% confidence interval [CI], 6.0%-11.7%), with a pooled incidence of renal replacement therapy of 3.6% (95% CI, 1.8%-7.1%).

The incidence of AKI was higher in critically ill patients (19.9%) compared with non-critical hospitalized patients (7.3%). Mortality was higher among critically ill patients with COVID-19 than in non-critically ill hospitalized patients with COVID-19 (33% vs 16.1%). The pooled estimated unadjusted odds ratio for mortality from AKI was 13.33 (95% CI, 4.05-43.91).

In meta-regression analysis, there was a positive association between the incidence of AKI and mortality in an adjusted model (Q 26.18; P=.02). Further, the adjusted model also demonstrated positive associations between age (P<.01), diabetes (P=.02), hypertension (P<.01), and baseline serum creatinine levels (P=.004) and the incidence of AKI.

In summary, the researchers said, “AKI is present in 8.3% of overall COVID-19 patients and in 19.9% of critically ill COVID-19 patients. Presence of AKI is associated with 13-fold increased risk of mortality. Age, diabetes, hypertension, and baseline serum creatinine levels are associated with increased AKI incidence. More studies, including the ones from multinational databases, are encouraged to confirm our findings.”

Source: Hansrivijit P, Boonpheng B, Thongprayoon C, Cheungpasitporn W, Ghahramani N. Incidence of AKI and its association with mortality in coronavirus disease 2019 (COVID-19) patients: A meta-analysis. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2020 (PO0664), October, 22, 2020.