Early versus late acute kidney injury among patients with COVID-19—a multicenter study from Wuhan, China
Suyuan Peng, Huai-Yu Wang, Xiaoyu Sun, Pengfei Li, Zhanghui Ye, Qing Li, Jinwei Wang, Xuanyu Shi, Liu Liu, Ying Yao, Rui Zeng, Fan He, Junhua Li, Shuwang Ge, Xianjun Ke, Zhibin Zhou, Erdan Dong, Haibo Wang, Gang Xu, Luxia Zhang, Ming-Hui Zhao
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfaa288
Background. Acute kidney injury (AKI) is an important complication of coronavirus disease 2019 , which could be caused by both systematic responses from multi-organ dysfunction and direct virus infection. While advanced evidence is needed regarding its clinical features and mechanisms. We aimed to describe two phenotypes of AKI as well as their risk factors and the association with mortality. Methods. Consecutive hospitalized patients with COVID-19 in tertiary hospitals in Wuhan, China from 1 January 2020 to 23 March 2020 were included. Patients with AKI were classified as AKI-early and AKI-late according to the sequence of organ dysfunction (kidney as the first dysfunctional organ or not). Demographic and clinical features were compared between two AKI groups. Their risk factors and the associations with inhospital mortality were analyzed. Results. A total of 4020 cases with laboratory-confirmed COVID-19 were included and 285 (7.09%) of them were identified as AKI. Compared with patients with AKI-early, patients with AKI-late had significantly higher levels of systemic inflammatory markers. Both AKIs were associated with an increased risk of in-hospital mortality, with similar fully adjusted hazard ratios of 2.46 [95% confidence interval (CI) 1.35-4.49] for AKIearly and 3.09 (95% CI 2.17-4.40) for AKI-late. Only hypertension was independently associated with the risk of AKI-early. While age, history of chronic kidney disease and the levels of inflammatory biomarkers were associated with the risk of AKIlate. Conclusions. AKI among patients with COVID-19 has two clinical phenotypes, which could be due to different mechanisms. Considering the increased risk for mortality for both phenotypes, monitoring for AKI should be emphasized during COVID-19.
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