Photo: The Feinstein Institutes for Medical Research
Doctors and researchers from across Northwell Health’s New York-based hospitals saw an “alarming number” of hospitalized coronavirus disease 2019 (COVID-19) patients develop acute kidney injury (AKI) during the height of the pandemic – rates higher than reported from China, according to new data published in Kidney International, the official journal of the International Society of Nephrology (ISN).
In the largest study of its kind to date, a team of investigators at the Feinstein Institutes for Medical Research analyzed the electronic health records (EHR) of 5,449 hospitalized COVID-19 patients between March 1, 2020, and April 5, 2020 and determined that 36.6 percent (1,993 patients) developed AKI. Among patients with AKI at the study’s conclusion, 39.1 percent (780 out of 1,993) were still hospitalized.
AKI is a sudden episode of kidney failure or damage, preventing waste from being filtered within the body and can often lead to death. Most cases developed early in a patient’s hospitalization, with 37.3 percent either arriving with AKI or developing it within 24 hours.
The number of patients requiring dialytic support at some point during their hospitalization was 285 or 5.2 percent of all patients, representing 14.3 percent of those with AKI. The link between respiratory failure and AKI was substantial. Among patients who required mechanical ventilation, 89.9 percent (1,068/1,190) developed AKI, compared to 21.7 percent (925/4259) in non-ventilated patients. Among patients who required mechanical ventilation, 23.2 percent (276 of 1,190) developed AKI and required dialysis therapy, compared to 0.2 percent (9 of 4,259) in non-ventilated patients.
In comparison to data from China, respiratory disease severity appeared to be less in China, as 13.4 percent of the Chinese patients required mechanical ventilation compared to 21.8 percent of the patients in the US study.
“Working amidst the COVID-19 epicenter was an experience we will never forget. Nephrologists and the dialysis staff were on the front lines of this battle trying to help every patient we could,” said Kenar D. Jhaveri, MD, a researcher at the Feinstein Institutes and corresponding author of the paper. “We hope to learn more about the COVID-19 related AKI in the coming weeks, and that by sharing what we have learned from our patients, other doctors and their patients can benefit.”
The study also revealed risk factors for developing AKI, including age, diabetes mellitus and cardiovascular disease, hypertension, and need for ventilation and vasopressor medications. Researchers also found those of the Black race were at increased risk for developing AKI.
“Dr. Jhaveri’s findings, based on the largest defined cohort of hospitalized Covid-19 patients, highlights the danger of kidney injury in this setting, an important new insight into this disease,” said Kevin J. Tracey, MD, CEO, and president of the Feinstein Institutes.
Future studies will look to better understand the causes of AKI and patient outcomes.