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Acute kidney injury in COVID-19: multicentre prospective analysis of registry data
BACKGROUND: Acute kidney injury (AKI) is a common and important complication of coronavirus disease 2019 (COVID-19). Further characterization is required to reduce both short- and long-term adverse outcomes. METHODS: We examined registry data including adults with confirmed severe acute respiratory...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083651/ https://www.ncbi.nlm.nih.gov/pubmed/34751235 http://dx.doi.org/10.1093/ckj/sfab071 |
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author | Wan, Yize I Bien, Zuzanna Apea, Vanessa J Orkin, Chloe M Dhairyawan, Rageshri Kirwan, Christopher J Pearse, Rupert M Puthucheary, Zudin A Prowle, John R |
author_facet | Wan, Yize I Bien, Zuzanna Apea, Vanessa J Orkin, Chloe M Dhairyawan, Rageshri Kirwan, Christopher J Pearse, Rupert M Puthucheary, Zudin A Prowle, John R |
author_sort | Wan, Yize I |
collection | PubMed |
description | BACKGROUND: Acute kidney injury (AKI) is a common and important complication of coronavirus disease 2019 (COVID-19). Further characterization is required to reduce both short- and long-term adverse outcomes. METHODS: We examined registry data including adults with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to five London Hospitals from 1 January to 14 May 2020. Prior end-stage kidney disease was excluded. Early AKI was defined by Kidney Disease: Improving Global Outcomes creatinine criteria within 7 days of admission. Independent associations of AKI and survival were examined in multivariable analysis. Results are given as odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals. RESULTS: Among 1855 admissions, 455 patients (24.5%) developed early AKI: 200 (44.0%) Stage 1, 90 (19.8%) Stage 2 and 165 (36.3%) Stage 3 (74 receiving renal replacement therapy). The strongest risk factor for AKI was high C-reactive protein [OR 3.35 (2.53–4.47), P < 0.001]. Death within 30 days occurred in 242 (53.2%) with AKI compared with 255 (18.2%) without. In multivariable analysis, increasing severity of AKI was incrementally associated with higher mortality: Stage 3 [HR 3.93 (3.04–5.08), P < 0.001]. In 333 patients with AKI surviving to Day 7, 134 (40.2%) recovered, 47 (14.1%) recovered then relapsed and 152 (45.6%) had persistent AKI at Day 7; an additional 105 (8.2%) patients developed AKI after Day 7. Persistent AKI was strongly associated with adjusted mortality at 90 days [OR 7.57 (4.50–12.89), P < 0.001]. CONCLUSIONS: AKI affected one in four hospital in-patients with COVID-19 and significantly increased mortality. Timing and recovery of COVID-19 AKI is a key determinant of outcome. |
format | Online Article Text |
id | pubmed-8083651 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-80836512021-05-03 Acute kidney injury in COVID-19: multicentre prospective analysis of registry data Wan, Yize I Bien, Zuzanna Apea, Vanessa J Orkin, Chloe M Dhairyawan, Rageshri Kirwan, Christopher J Pearse, Rupert M Puthucheary, Zudin A Prowle, John R Clin Kidney J Original Article BACKGROUND: Acute kidney injury (AKI) is a common and important complication of coronavirus disease 2019 (COVID-19). Further characterization is required to reduce both short- and long-term adverse outcomes. METHODS: We examined registry data including adults with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to five London Hospitals from 1 January to 14 May 2020. Prior end-stage kidney disease was excluded. Early AKI was defined by Kidney Disease: Improving Global Outcomes creatinine criteria within 7 days of admission. Independent associations of AKI and survival were examined in multivariable analysis. Results are given as odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals. RESULTS: Among 1855 admissions, 455 patients (24.5%) developed early AKI: 200 (44.0%) Stage 1, 90 (19.8%) Stage 2 and 165 (36.3%) Stage 3 (74 receiving renal replacement therapy). The strongest risk factor for AKI was high C-reactive protein [OR 3.35 (2.53–4.47), P < 0.001]. Death within 30 days occurred in 242 (53.2%) with AKI compared with 255 (18.2%) without. In multivariable analysis, increasing severity of AKI was incrementally associated with higher mortality: Stage 3 [HR 3.93 (3.04–5.08), P < 0.001]. In 333 patients with AKI surviving to Day 7, 134 (40.2%) recovered, 47 (14.1%) recovered then relapsed and 152 (45.6%) had persistent AKI at Day 7; an additional 105 (8.2%) patients developed AKI after Day 7. Persistent AKI was strongly associated with adjusted mortality at 90 days [OR 7.57 (4.50–12.89), P < 0.001]. CONCLUSIONS: AKI affected one in four hospital in-patients with COVID-19 and significantly increased mortality. Timing and recovery of COVID-19 AKI is a key determinant of outcome. Oxford University Press 2021-03-27 /pmc/articles/PMC8083651/ /pubmed/34751235 http://dx.doi.org/10.1093/ckj/sfab071 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Wan, Yize I Bien, Zuzanna Apea, Vanessa J Orkin, Chloe M Dhairyawan, Rageshri Kirwan, Christopher J Pearse, Rupert M Puthucheary, Zudin A Prowle, John R Acute kidney injury in COVID-19: multicentre prospective analysis of registry data |
title | Acute kidney injury in COVID-19: multicentre prospective analysis of registry data |
title_full | Acute kidney injury in COVID-19: multicentre prospective analysis of registry data |
title_fullStr | Acute kidney injury in COVID-19: multicentre prospective analysis of registry data |
title_full_unstemmed | Acute kidney injury in COVID-19: multicentre prospective analysis of registry data |
title_short | Acute kidney injury in COVID-19: multicentre prospective analysis of registry data |
title_sort | acute kidney injury in covid-19: multicentre prospective analysis of registry data |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083651/ https://www.ncbi.nlm.nih.gov/pubmed/34751235 http://dx.doi.org/10.1093/ckj/sfab071 |
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