PMID- 33011717 OWN - NLM STAT- MEDLINE DCOM- 20201109 LR - 20211204 IS - 1421-9670 (Electronic) IS - 0250-8095 (Print) IS - 0250-8095 (Linking) VI - 51 IP - 10 DP - 2020 TI - Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications. PG - 786-796 LID - 10.1159/000511160 [doi] AB - BACKGROUND: Although diffuse alveolar damage and respiratory failure are the key features of coronavirus disease 2019 (COVID-19), the involvement of other organs such as the kidney has also been reported. The reports of the incidence of acute kidney injury (AKI) in COVID-19 patients vary widely. In this study, we report our unique experience with AKI in COVID-19 patients in a low socioeconomic and predominantly ethnic minority group and provide its incidence, risk factors, and prognosis to expand the current understanding of this complication. METHODS: In this single-center, retrospective cohort study, we analyzed the data of 469 COVID-19 patients admitted to the Brookdale University Hospital in Brooklyn, NY, from March 18 through April 23, 2020. Information regarding demographics, comorbidities, medications, clinical and laboratory data, and outcomes was collected from the electronic medical records. Both univariate and multivariate analyses were performed to determine the association of AKI with in-hospital mortality. RESULTS: The median age was 66 years (interquartile range [IQR] 25-75; range 19-101 years), and 268 (57.14%) patients were male. Estimated glomerular filtration rate (eGFR) as determined by the Modification of Diet in Renal Disease Study Equation was low (<60 mL/min/1.73 m2) in 207 (44.1%) patients. During hospitalization, 128 (27.3%) patients developed AKI, and the incidence was significantly higher in those patients presenting with a low eGFR (N = 81, 39.1%; p < 0.001). Male sex, hypertension, the use of angiotensin-converting enzyme inhibitors and non-steroidal anti-inflammatories, hemodynamic instability, mechanical ventilation, acute respiratory distress syndrome, and admission elevated ferritin, creatinine kinase, brain natriuretic peptide, and troponin 1 were identified as the risk factors for in-hospital AKI. Ninety-seven (28.45%) patients died in the non-AKI group versus 91 (71.1%) in the AKI group (p < 0.001). The Cox proportional hazard model after adjusting for age, gender, comorbidities, hemodynamic status, and PF ratio (arterial oxygen partial pressure [PaO2]/fractional inspired oxygen [FiO2]) determined that on admission, an elevated blood urea nitrogen (hazard ratio [HR]: 1.75; 95% confidence interval [CI] 1.23-2.48), a low eGFR (HR 1.43; CI 1.1-2.03), AKI stage 1 (HR 1.14; CI 0.64-2.03), AKI stage 2 (HR 1.86; CI 1.03-3.56), and AKI stage 3 (HR 2.1; CI 1.3-2.81) were independent risk factors for in-hospital mortality. Renal replacement therapy (RRT) did not improve survival in stage III AKI. CONCLUSION: AKI in our hospitalized COVID-19 patients was common and carried a high mortality, especially in patients with AKI stage 3. RRT did not improve survival. Policy changes and planning for this high incidence of AKI in COVID-19 patients and its associated high mortality are necessary at the local and national levels. CI - (c) 2020 S. Karger AG, Basel. FAU - Zahid, Umar AU - Zahid U AD - Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Ramachandran, Preethi AU - Ramachandran P AD - Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Spitalewitz, Samuel AU - Spitalewitz S AD - Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Alasadi, Lutfi AU - Alasadi L AD - Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Chakraborti, Abhishek AU - Chakraborti A AD - Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Azhar, Muhammad AU - Azhar M AD - Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Mikhalina, Galina AU - Mikhalina G AD - Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Sherazi, Andleeb AU - Sherazi A AD - Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Narh, Joshua Tetteh AU - Narh JT AD - Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. FAU - Khattar, Pallavi AU - Khattar P AD - Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. FAU - Bedi, Puneet AU - Bedi P AD - Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA, pbedi@bhmcny.org. LA - eng PT - Journal Article DEP - 20201002 PL - Switzerland TA - Am J Nephrol JT - American journal of nephrology JID - 8109361 SB - IM CIN - Am J Nephrol. 2021;52(1):84. PMID: 33540408 MH - Acute Kidney Injury/diagnosis/*mortality/therapy/virology MH - Adult MH - Aged MH - Aged, 80 and over MH - Betacoronavirus/isolation & purification/*pathogenicity MH - COVID-19 MH - Coronavirus Infections/*complications/epidemiology/virology MH - Ethnicity/statistics & numerical data MH - Female MH - Hospital Mortality MH - Hospitals, Urban/*organization & administration/statistics & numerical data MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Minority Groups/statistics & numerical data MH - New York City/epidemiology MH - Pandemics MH - Pneumonia, Viral/*complications/epidemiology/virology MH - *Policy MH - Prognosis MH - Renal Replacement Therapy/statistics & numerical data MH - Retrospective Studies MH - Risk Factors MH - SARS-CoV-2 MH - Socioeconomic Factors MH - Survival Analysis MH - Treatment Outcome MH - Young Adult PMC - PMC7573899 OTO - NOTNLM OT - Acute kidney injury OT - Acute respiratory distress syndrome OT - Coronavirus disease 19 OT - In-hospital mortality COIS- The authors have no conflicts of interests to declare. EDAT- 2020/10/05 06:00 MHDA- 2020/11/11 06:00 PMCR- 2020/10/20 CRDT- 2020/10/04 20:33 PHST- 2020/05/18 00:00 [received] PHST- 2020/08/24 00:00 [accepted] PHST- 2020/10/05 06:00 [pubmed] PHST- 2020/11/11 06:00 [medline] PHST- 2020/10/04 20:33 [entrez] PHST- 2020/10/20 00:00 [pmc-release] AID - 000511160 [pii] AID - ajn-0001 [pii] AID - 10.1159/000511160 [doi] PST - ppublish SO - Am J Nephrol. 2020;51(10):786-796. doi: 10.1159/000511160. Epub 2020 Oct 2.