Clinical Characteristics and Short-Term Outcomes of Severe AKI in COVID-19 in Bronx, New York

Background: After the first reported case of COVID-19 in the U.S., New York City quickly became the epicenter of the pandemic. AKI has been reported in patients with severe COVID-19. The Bronx consists of a predominantly minority population with a high burden of comorbidities that may be at increased risk for AKI in the setting of COVID-19. We aimed to characterize risk factors and short term outcomes in patients hospitalized with COVID-19 and severe AKI. Methods: We performed a retrospective study of 113 adults hospitalized with COVID-19 in a large healthcare system in the Bronx who required nephrology consultation for AKI from March 11-March 30, 2020. We extracted data on demographics, comorbidities, admission vital signs and labs, need for mechanical ventilation, renal replacement therapy (RRT), in-hospital death and discharge. AKI was defined by KDIGO criteria. Chi-square analyses and Wilcoxon tests were used. Data was censored on April 12, 2020. All patients had ≥ 14 days of follow up. Results: Mean age was 63 (SD 12) years old; 69% were men and 33% were Black and 23% were Hispanic. Forty-five patients (39.8%) had chronic kidney disease, 58(51%) had diabetes mellitus and 87(77%) had hypertension. The majority presented with AKI within 24 hours of admission and 75% had Stage 3 AKI. Ninety-two (81%) patients had proteinuria and 53(47%) had hematuria. Intensive care unit (ICU) was required in 62(55%), 64(57%) required mechanical ventilation, 56(49.5%) required RRT and 18(16%) were not candidates for RRT. In-hospital death occurred in 68(60%) and 22% were discharged. Of those who required RRT, in-hospital death occurred in 35(62.5%) and only 6 patients were discharged, 5 of whom remained RRT dependent. Heavy proteinuria (3-4+ on urinalysis) and initial C-reactive protein (CRP) were higher in those with AKI who died [21.1 (IQR 14.3-29.6) versus 6.6 (3.2-16.3), p<0.001]. Conclusions: Severe AKI in the setting of COVID-19 is associated with increased utilization of ICU, mechanical ventilation, and RRT. Outcomes are poor in those with Stage 3 AKI, underscoring the need for palliative care involvement and early goals of care discussions. Elevated initial CRP and heavy proteinuria may be useful to risk stratify patients with COVID-19 and severe AKI at increased risk for mortality.