tetano
Editor, Senior Moderator
Cardiorenal Med
. 2020 Jun 18;1-9.
doi: 10.1159/000509182. Online ahead of print.
Clinical Characteristics and Outcomes of Community- And Hospital-Acquired Acute Kidney Injury With COVID-19 in a US Inner City Hospital System
Jerald Pelayo[SUP] 1 [/SUP], Kevin Bryan Lo[SUP] 2 [/SUP], Ruchika Bhargav[SUP] 2 [/SUP], Fahad Gul[SUP] 2 [/SUP], Eric Peterson[SUP] 2 [/SUP], Robert DeJoy Iii[SUP] 2 [/SUP], Grace Faith Salacup[SUP] 2 [/SUP], Jeri Albano[SUP] 2 [/SUP], Akshaya Gopalakrishnan[SUP] 3 [/SUP], Zurab Azmaiparashvili[SUP] 2 [/SUP], Gabriel Patarroyo-Aponte[SUP] 2 4 5 [/SUP], Janani Rangaswami[SUP] 2 5 [/SUP]
Affiliations
Abstract
Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population.
Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI.
Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121-13.231, p = 0.032).
Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.
Keywords: Acute kidney injury; COVID-19; Heart failure; Novel coronavirus.
. 2020 Jun 18;1-9.
doi: 10.1159/000509182. Online ahead of print.
Clinical Characteristics and Outcomes of Community- And Hospital-Acquired Acute Kidney Injury With COVID-19 in a US Inner City Hospital System
Jerald Pelayo[SUP] 1 [/SUP], Kevin Bryan Lo[SUP] 2 [/SUP], Ruchika Bhargav[SUP] 2 [/SUP], Fahad Gul[SUP] 2 [/SUP], Eric Peterson[SUP] 2 [/SUP], Robert DeJoy Iii[SUP] 2 [/SUP], Grace Faith Salacup[SUP] 2 [/SUP], Jeri Albano[SUP] 2 [/SUP], Akshaya Gopalakrishnan[SUP] 3 [/SUP], Zurab Azmaiparashvili[SUP] 2 [/SUP], Gabriel Patarroyo-Aponte[SUP] 2 4 5 [/SUP], Janani Rangaswami[SUP] 2 5 [/SUP]
Affiliations
- PMID: 32554965
- DOI: 10.1159/000509182
Abstract
Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population.
Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI.
Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121-13.231, p = 0.032).
Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.
Keywords: Acute kidney injury; COVID-19; Heart failure; Novel coronavirus.