Incidence of AKI in Hospitalized Patients with COVID-19

Background: Preliminary reports indicate that acute kidney injury (AKI) is common in coronavirus disease (COVID-19) patients and is associated with worse outcomes. AKI in hospitalized COVID-19 patients in the United States is not well-described. Methods: This is a retrospective observational study of patients aged ≥18 years with laboratory confirmed COVID-19 admitted to the Mount Sinai Health System between February 27 and April 15, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aOR) for mortality while adjusting for age, gender, race, comorbidities, and admission labs and vital signs. Results: Of 3,235 hospitalized patients with COVID-19, AKI occurred in 1406 (46%) patients and 280 (20%) with AKI required dialysis. The proportion with stages 1, 2, and 3 AKI overall was 35%, 20%, 45%, and 20% received dialysis (Figure 1A). In the 815 patients admitted to the intensive care unit (ICU), 553 (68%) had AKI and 34% required dialysis. The median peak serum creatinine was 2.2 (IQR 1.6-3.7) mg/dL in those that did not receive dialysis and was 8.6 (IQR 6.5-11.4) mg/dL in those that did receive dialysis. Urine studies were available for 581 (18%) patients of whom 338 (60%) patients had AKI. 558 (96%) of all patients had any urinary abnormalities of proteinuria, hematuria, or leukocyturia. Independent predictors of severe AKI were chronic kidney disease, systolic blood pressure, and potassium at baseline. In-hospital mortality in patients with AKI was 41%. The aOR for mortality for AKI was 9.6 (95% CI 7.4-12.3). 56% of patients with AKI who were discharged recovered kidney function back to baseline (Figure 1B). Conclusions: AKI is common in patients hospitalized with COVID-19, associated with worse mortality, and nearly half of patients do not recover kidney function.